Undiagnosed Vertically Acquired HCV Infection Leading to Hepatocellular Carcinoma and Liver Transplant in an Adolescent Female: A Case Report

Case Report

J Hepat Res. 2015;2(2): 1023.

Undiagnosed Vertically Acquired HCV Infection Leading to Hepatocellular Carcinoma and Liver Transplant in an Adolescent Female: A Case Report

Andrea Barreto¹, Amanda Fifi¹, Claudia Rojas² and Aymin Delgado-Borrego3,4*

1Division of Pediatric Gastroenterology, Hepatology and Nutrition.University of Miami, Miller School of Medicine, USA

2Division of Pediatric Pathology, University of Miami, Miller School of Medicine, USA

3KIDZ Pediatric Multispecialty Center, Division of Gastroenterology, Hepatology and Nutrition, USA

4Department of Pediatric Gastroenterology, Boston Children’s Hospital, USA

*Corresponding author: Aymin Delgado-Borrego, Pediatric Gastroenterologist and Hepatologist, Division of Pediatric Gastroenterology, Hepatology and Nutrition, KIDZ Pediatric Multispecialty Center, 2600 Immokalee Road Naples, FL 34110, USA

Received: April 23, 2015; Accepted: June 19, 2015; Published: June 24, 2015


Hepatitis C virus (HCV) infection remains a global health concern and is the most common blood-borne infection in the United States (U.S.). According to results obtained from the Third National Health and Nutrition Examination Survey, 0.6% of children and adolescents 6 to 19 years of age were found to be infected with HCV in the U.S.However, it is important to note that the majority of children infected with HCV have not been diagnosed. Hepatocellular Carcinoma (HCC) is uncommon in chronically infected children, with few reported cases in the literature. This case describes the development of HCC in an otherwise healthy individual who acquired HCV through vertical transmission and highlights the importance of vigilance of this infection to prevent delay in diagnosis and institution of appropriate management.

Keywords: Hepatitis C; Hepatocellular carcinoma

Case Presentation

The patient, H.S., is a 17-year-old child of an HCV infected mother. She has a history of psoriasis treated topically and nephrolithiasis treated with lithotripsy. Her mother died from complications of HCV infection when the patient was 10 years old and her father has Chronic Hepatitis C (CHC) infection with chronic liver failure.

H.S. presented in May 2011 to the emergency room (ER) complaining of generalized weakness. On physical examination, she had minimal jaundice and ascites, and laboratory testing revealed elevated liver enzymes and a prolonged Prothrombin Time/ International Normalized Ratio (PT/INR). She was admitted to the inpatient floor for further evaluation and tested positive for HCV antibodies, infection was later confirmed by Polymerase Chain Reaction (PCR) and genotyping (initial viral load was 9 million IU/ml, genotype 1a) (Figure 1). She underwent a liver biopsy that revealed cirrhosis. Initially, there was no immediate treatment plan and no communication between clinicians who established the diagnosis and those with the expertise to treat her. H.S. contacted a social worker at her high school in search of a physician to treat her infection. The social worker called the Miami Dade Public Health Department who ultimately referred her to a pediatric hepatologist at Holtz Children’s Hospital. H.S was seen in clinic in June 2011 and was found to be stable. Further laboratory testing was done at the time including assessment of her immunization status to hepatitis A and B. Abdominal ultrasound (US) with Doppler was consistent with cirrhosis and ascites with no evidence of focal masses. She was started on furosemide and spironolactone.