At the 5-th meeting of the student scientific circle at the Department of Propaedeutics of Children Diseases, a clinical case of cirrhosis of the liver and congenital agenesis of the gallbladder in a child of the first year of life was considered. The child was born from an HIV-infected mother, at 35 weeks of pregnancy, by caesarean section, from twins. The birth weight was 2350 g., height 47 cm. The mother has a burdened medical history (HIV since 2012), and the child began receiving treatment from the age of 6 weeks – retrovir, zeffix and biseptol.
Objective data showed that the child’s condition is extremely severe due to portal hypertension, liver and pancreatic insufficiency, encephalopathy and severe anemia. The skin has a dirty yellowish, greenish color, paleness of the palms and feet is noted, as well as a hemorrhagic rash. The child has a sharp lag in physical and psychomotor development.
The results of ultrasound and CT scan of abdominal organs showed signs of liver cirrhosis, hepatosplenomegaly, portal hypertension and other pathologies. The diagnosis was established as decompensated, secondary biliary cirrhosis of the liver of class C according to Child-Pugh. PELD 23 points.
Сongenital malformation of the gall bladder: agenesis of the gallbladder. Portal hypertension. Hepatic encephalopathy. Secondary coagulopathy. Secondary thrombocytopenia. Chronic CMVI. Severe anemia. Severe protein-energy deficiency. Umbilical and inguinal hernias
The issue of liver transplantation was considered and a suitable donor was found – the father of the child. However, unfortunately, the child did not live to be transplanted.
The findings showed that this clinical case is a severe combined congenital pathology of biliary tract abnormality and generalized cytomegalovirus infection. Decompensated cirrhosis of the liver is explained by two factors – CMVI and malformation of the biliary system. There is also an adverse effect of the maternal anamnesis and the premorbid background of the child on the course of the disease. This clinical case aroused great interest among stutents.
