ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

1 - Paediatric Gastroenterology And Hepatology Unit, Hospital Dona Estefânia, Lisbon, Portugal,
2 - Infeciology Unit, Hospital Dona Estefânia, Lisbon, Portugal,

- Poster, XXXVI Reunião Anual da Sociedade Portuguesa de Gastrenterologia, Hepatologia e Nutrição Pediátrica, Porto, 14-15 de março de 2024
- Poster, 56th Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology and Nutricion (ESPGHAN), Milão, 15-18 de maio 2024

RESUMO:
Objectives and Study: When addressing jaundice in adolescents, the differential diagnosis is broad. In the workup of hepatitis at this age, a comprehensive social history is essential to consider and rule out potential etiologies.
Methods: We describe the case of a healthy 16-year-old female who presented to the emergency room with a 2-week history of malaise, jaundice and intermittent choluria. No infections, medication use or exposure to potential toxics were reported. No personal or family history of autoimmunity were stated, and immunizations were up-to-date.
Results: Physical examination revealed icteric sclera and jaundice without organomegaly or signs of liver disease. Initial investigations disclosed significatively elevated transaminases with a mixed cytolytic and cholestatic pattern but no liver dysfunction (Table 1). Abdominal ultrasound yielded normal results, and the patient was admitted for evaluation. Common causes, including viral hepatitis, HIV, EBV, CMV were ruled out. Autoimmunity testing revealed only a positive antinuclear antibody of 1:160 but a normal IgG. Additional evaluation including for Wilson disease was negative. Due to reported sexual activity, sexually transmitted infections screening was performed alongside the initial workup for cholestasis. Serum tests for specific anti-Treponema pallidum antibodies were positive, confirmed by a positive rapid plasma regain and a positive treponema pallidum hemaglutination assay. The patient received the first of three doses of 2.4 million units of penicillin G benzathine for secondary syphilis and was discharged with supportive therapy and a follow-up plan. Over the next four months the patient’s condition improved with normalization of laboratory values (table 1).