Laboratory testing included a CBC and CMP which were within normal limits except AST 451 (7-40 U/L), ALT 594 (5-50 U/L) and GGT 88 (0-50 U/L).
At the initial presentation, thoracic spine and chest x-rays Case Photo #1 were unremarkable. An ultrasound of the spleen was obtained and noted splenomegaly (16cm) without hematoma, laceration or free fluid. Case Photo #2
The patient was sent for CT of the chest and abdomen which demonstrated no acute findings, no fractures identified and confirmed splenomegaly with no focal lesions. Case Photo #3 Case Photo #4
Further laboratory investigation was positive for liver-kidney microsomal and smooth muscle antibodies, otherwise the remaining laboratory results were within normal limits, including PT/INR, PTT, hepatitis panel, WSR, ANA, ceruloplasmin, 24-hour urine copper, alpha-1 antitrypsin phenotype, celiac disease antibodies, EBV IgM, EBV IgG and CMV IgM.
He was referred to pediatric gastroenterology. He underwent an US-guided liver biopsy that revealed chronic hepatitis consistent with autoimmune hepatitis grade II of IV, stage 4 of 4.
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