RARE HEMATOLOGICAL COMPLICATION OF HEPATITIS A IN CHILDREN:BONE MARROWAPLASIA IN A CASE REPORT

Introduction: Complicated forms of hepatitis A, particularly hematological complications, are rare and are described as severe conditions in children. Case Report: This case involves a 4-year-and-4-month-old girl who initially presented with a cholestatic jaundice flare due to viral hepatitis A. The symptomatology became complicated a month later by a hemorrhagic syndrome consisting of recurrent epistaxis, pallor, and asthenia, evolving in a context of prolonged fever and deterioration of the general condition. Clinical examination found a febrile child at 39°C, generalized cutaneous-mucosal pallor, petechial purpuric spots on the trunk, and no hepatosplenomegaly. The hematological workup showed aregenerative pancytopenia with normal transaminases. The myelogram revealed a poor bone marrow. Bone marrow biopsy confirmed bone marrow aplasia. Vitamin B12 and B9 levels were normal. Serologies for HBV, HCV, EBV, and CMV were negative. HVA IgG serology was positive with borderline HVA IgM. The patient was put on transfusion support with third- generation cephalosporin and aminoglycoside antibiotics. The diagnosis of post-hepatitis acquired bone marrow aplasia was confirmed. Treatment with cyclosporine was started, leading to good clinical evolution and improvement of the hemogram after two months of follow-up. Conclusion: Although hematological complications of hepatitis A are still rare, they remain fatal in the majority of cases. This underscores the need for biological and clinical monitoring in the management of hepatitis A in children.