ACUTE HEPATITIS A WITH UNRECOGNIZED G6PD DEFICIENCY LEADING TO ACUTE LIVER FAILURE IN CHILDREN: A CASE SERIES OF 3 SUCCESSFULLY MANAGED CASES

Dr. Sunali Jamwal, Dr. Advaita Sharma and Dr. Shivani Cherwoo*

Background: Hepatitis A virus (HAV) infection is usually self-limiting in children but may take a severe course when complicated by glucose-6-phosphate dehydrogenase (G6PD) deficiency, particularly when undiagnosed. Objective: To describe clinical presentation, management, and outcomes of three children with acute hepatitis A and previously unrecognized G6PD deficiency presenting as acute liver failure. Methods: Three male children aged 4, 7, and 11 years, none previously diagnosed with G6PD deficiency, presented over one year with acute liver failure. HAV infection was confirmed by ELISA in all cases. Results: All patients presented with vomiting, abdominal pain, jaundice, and dark urine. Common signs included pallor, jaundice, and encephalopathy. One patient presented with hypoxemia and severe anemia (hemoglobin <5 g/dL). All had bilirubin >20 mg/dL with cholestasis and liver enzymes elevated more than 25 times the upper limit of normal. LDH was >1000 IU/L in all cases. All required mechanical ventilation for hepatic encephalopathy. The highest INR was 4.8. All patients were successfully managed with supportive care and discharged in stable condition. Conclusion: Acute hepatitis A in children with previously unrecognized G6PD deficiency can lead to severe acute liver failure with significant hemolysis and cholestasis. Early recognition and supportive care can ensure favorable outcomes.