A 4-year-oldinfant boy with a history of soft tissue tuberculosis was treated at the age of one year. In November 2021, he was admitted to a university hospital with acute jaundice, fever, and vomiting. He was diagnosed with acute liver failure as a result of an infection with hepatitis A virus. The anti-HAV antibody immunoglobulin M (IgM) was elevated, and antibody immunoglobulin G (IgG) was negative. It was detected by using an enzyme-linked immunosorbent assay (ELISA). It was confirmed by the detection of HAV by real-time PCR. Serological tests for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), cytomegalovirus (CMV), toxoplasmosis, rubella, and EBV were all negative. The infant still had a high fever, asthenia, and myalgia a week later. The patient had a painful case of hepatomegaly and splenomegaly. Following a thorough examination, the patient was diagnosed with sepsis. Despite supportive antibiotic treatment, he deteriorated with persistent fever and irritability. The liver was palpable at 10 cm with a hepatic arrow, but the rate was not. In addition to a macular rash and edema in the lower and upper extremities, the following laboratory results were obtained: hemoglobin 5.5 g/dL, mean corpuscular volume (MCV) 81.2 fL, white blood cell count (WBC) 0.62 103/muL, and platelet count 97 103/muL. Transaminase levels were found to be elevated in the initial laboratory examination (Table 1).
Urine cultures came back negative. However, the blood culture revealed the presence of two bacteria: Leuconostoc citreum and Brevibacterium ravenspurgense; he was treated with antibiotics, but the fever and asthenia persisted. An aspiration of bone marrow revealed the presence of histiocytes and lymphocytes at the medullary level. For three days, he received steroids via IV at a dose of 1 g/1.73 m2 and additional steroids via OS. On the third day of treatment, the patient's fever returned to normal, and his overall condition improved. On the fifth day of treatment, his ferritin level was reduced to 760 ng/L and his WBC level increased to 14400/mm3. His overall health had improved. The patient was discharged ten days later with no complaints. At the fourth month of follow-up, he was in good health.