Differential diagnosis of postoperative liver failure in a 12-year-old child.
The case of a 12-year-old child who died of fulminant hepatic failure a few days after tonsillectomy is reported. Histological examination revealed large areas of massive centrilobular hepatic necrosis. Hepatotoxicity of postoperatively administered paracetamol in high dosages combined with enflurane exposure is discussed as a cause for the hepatic failure. The fulminant clinical course could have been influenced by an infection with hepatitis G virus which was detected in liver tissue by in situ hybridisation and was probably transmitted via transfusion of blood plasma.
Hausmann
R
R
Department of Legal Medicine, University of Erlangen-Nuremburg, Germany.
Schmidt
B
B
Schellmann
B
B
Betz
P
P
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D002648:Child; D003937:Diagnosis, Differential; D004357:Drug Synergism; D004737:Enflurane / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006501:Hepatic Encephalopathy / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology*; D014068:Tonsillectomy
D018712:Analgesics, Non-Narcotic; D018685:Anesthetics, Inhalation; D000082:Acetaminophen; D004737:Enflurane