Influenza B Infection Causing Acute Hepatitis, Anemia and Thrombocytopenia

Case Report

Austin J Clin Med. 2016; 3(1): 1025.

Influenza B Infection Causing Acute Hepatitis, Anemia and Thrombocytopenia

Valiere Alcena

Clinical Professor, Department of Medicine, Albert Einstein College of Medicine Bronx, Adjunct Professor of Medicine New York Medical College Valhalla, NY, USA

*Corresponding author: Valiere Alcena, Clinical Professor, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, Adjunct Professor of Medicine New York Medical College Valhalla, NY, USA

Received: March 07, 2016; Accepted: March 28, 2016; Published: March 29, 2016

Abstract

An interesting case of Influenza B infection with acute viral hepatitis, diffuse skin rash, fever, leukocytosis, eosinophilia, anemia, thrombocytopenia and very high liver function tests.

Keywords: Influenza B infection; Acute hepatitis; Fever; Anemia; Thrombocytopenia

Case Presentation

A 57-year-old Black female became sick with flu like symptoms with general weakness, muscles ache; pain in lower back, legs, shoulders with headaches, and low-grade fever 3 weeks before presenting to the emergency room on February 15, 2016 extremely. Patient works as a transporter of patients at a hospital.

At the ER she was very weak, had a temperature of 102.5 F, Pulse 114, Blood pressure of 107/87, respiratory rate of 22 and O2 SAT of 100% room air. Physical examination was remarkable for a diffuse erythematous rash, HEENT was remarkable for 1+ scleral icterus, lungs were clear, cardiac examination was remarkable only for a heart rate 114 per minutes abdominal examination was negative, neurological examination was negative and patient remained alert and oriented all time, extremities were negative. Recto-pelvic examinations refused by patient.

An IV fluid of D5/normal saline was started at 125cc per hour. CBC with diff, complete metabolic profile, urinalysis, urine culture, blood culture x2, PT, UNR. PTT, blood for Influenza A&B antibodies were sent to the lab, VDRL Lyme disease, monospot, CMV, Rickettsia antibodies, Rocky Mountain Spotted fever antibodies, Coxsackie antibodies, Dengue fever antibodies, VDRL, HIV 1 & 2, Malarial smear, Babesia, hepatitis A, B. C, D and E were done [1,2].

Chest ray, Abdominal CT, Abdominal ultrasound, CT angio, Ultrasound of the legs, Brain MRI and EKG were done.

The patient was admitted to the hospital. In the hospital, she was empirically started on Doxycycline 100mg PO BID and hydrocortisone cream QID for the skin rash, Tylenol 650mg Q4h PRN for fever. On the fourth hospital 2/19/16, her HCT dropped to 23.9% and platelets count dropped to 17,000 and her eosinophil went up to 27%. She was transfused with 2 units of packed red blood cells and 1uint of platelets [3].

In addition, she was treated with Venofer 100mg IV daily and Procrit 10,000 units SC daily. She was also given Folic acid 1mg IV BID because her HGB electrophoresis shows Sickle cell trait SA.

On 2/28/16 her WBC went up to 17.300 ad her LFTs were very high.

Her Influenza B IGM < 1:10.

Her Influenza B IgG came back 1: 640, indicating that her viral illness was due to Influenza B.

The viral syndrome she experienced three weeks before admission was the result of Influenza B, which resulted in the high Influenza B IgG of 1: 640 [4,5].

Influenza A PCR is negative.

The Abnormal Blood Tests Results Found Include

Markedly elevated LFTs,

Severe anemia,

Severe Thrombocytopenia,

Very high eosinophil level,

Sickle cell trait SA (not known to the patient before),

High PT/INR,

Factor VII deficiency (not known to the patient before),

Influenza B IgG 1:640.

The patient got better and went home on 2/23/16 with a WBC of 10.600 and an HCT of 32.4%, Platelets count of 83,000 and LFTs that were almost back to normal. The skin rash much improved and overall clinically much improved.

See tables for hospital course and lab tests results: (Table 1,2,3,4,5,6,7)

Patient was seen in the office on 3/2/16 she was feeling much better and her physical examination was completely normal. She is almost back to normal except for lingering weakness (Table 8).