A 14-Year-Old Boy With Hepatic Failure and Hypotension

Authors:Aurelia Balan, MD; Mary Mancao, MDSeries Editors: Sheryl Falkos, MD; Rosa A Vidal, MD


February 25, 2005


The patient is a 14-year-old previously healthy white boy transferred to our institution for treatment of hepatic failure and hypotension.

He had a 2-day history of fever up to 104o F (40o C), generalized myalgias and arthralgias (prominent in right shoulder and right hip), malaise, mild frontal headache, and a few episodes of nonprojectile vomiting. Other pertinent history included abrasions to his left elbow and left lower extremity sustained while swimming at a local pond 4 days prior to hospital admission.

One day prior to admission, he was evaluated by his primary care physician (PCP) and prescribed ibuprofen. On the day of admission, he was reevaluated by his PCP because his mother noted he was jaundiced. At the PCP's office, his systolic blood pressure was 75/46 mm Hg, with orthostasis present. He was subsequently taken to the local emergency room (ER) for further evaluation of his jaundice and hypotension. At the local ER, he continued to be hypotensive. Lab analyses showed elevated serum transaminases and a high total and indirect bilirubin; coagulation studies were abnormal. He was then transferred to the local pediatric intensive care unit (PICU) for further management.