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Published 26 February 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.08.2008.0623]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Reminder of important clinical lesson

Human herpesvirus type 6 hepatitis or familiar intrahepatic cholestasis: the importance of follow-up

Valerio Nobili1, Andrea Pietrobattista1, Paola Francalanci1, Ilaria Giovannoni1, Matilde Marcellini1, Sandro Vento2

1 Bambino Gesu Children’s Hospital, S.Onofrio 4 square, Rome, 00165, Italy
2 Hospital of Cosenza, Cosenza, Cosenza, 00234, Italy

Correspondence to:
nobili66{at}yahoo.it

SUMMARY

A 1-month-old child presented to our unit with jaundice and raised aminotransferases, {gamma}-glutamyltranspeptidase and bilirubin. Metabolic diseases were ruled out and ultrasound found no alterations. Human herpesvirus type 6 (HHV-6) DNA was found in blood and saliva and IgG anti-HHV-6 in serum, and a diagnosis of HHV-6 hepatitis was made. In the following weeks, aminotransferase values remained raised while {gamma}-glutamyltranspeptidase levels returned to normal in 45 days. At the age of 5 months symptoms and elevated aminotransferases persisted and immunohistochemistry performed on liver tissue allowed a diagnosis of progressive familiar intrahepatic cholestasis type 2 to be made. The patient is now 7 months old, and cholestatic jaundice and pruritus continue to be present.


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