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Acute Liver Dysfunction in the Course of Norovirus Gastroenteritis in Cerebral Palsy on Baclofen |
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Bundang Jesaeng General Hospital, Department of Rehabilitation Medicine1 |
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Jee Hyun Suh1*†, Eun Chae Lee1, Gyu Seong Kim1 |
Introduction: Norovirus is the common cause of gastroenteritis in humans. There is no report of liver dysfunction in children caused by norovirus infection. Baclofen has been used mainly to treat spasticity in children with cerebral palsy (CP). Hepatotoxicity of baclofen has not been previously described in children. This report describes the case of acute liver dysfunction in the course of norovirus gastroenteritis in a child with CP on baclofen.
Case Report : A 7-year 7month-old child who diagnosed spastic quadriplegic cerebral palsy (Gross Motor Function Classification System level V) showed mild fever and diarrhea. He fed on the enteral nutrition fluid (Encover solution) by PEG tube. The patient weighed 22.4 kg for a height of 115 cm. He started taking baclofen a week before the symptom started (Figure 1). His illness was diagnosed as norovirus gastroenteritis, but liver dysfunction accompanied this gastroenteritis (AST/ALT 589/401 (IU/L)) (Figure 1, Table 1). He recovered completely within 2 weeks without any damage left.
Discussion: Norovirus gastroenteritis is known to have no serious effect on the liver function. It is also known that baclofen excretes 85% of the kidneys, and therefore does not raise AST/ALT seriously. Although each of these situations may not be able to cause significant liver dysfunction, it can cause a serious AST/ALT elevation when two situations overlap. From this point of view, this case report has great implications. This case report suggests that when norovirus enteritis occurs in children taking baclofen, the AST/ALT level must be checked and prompt management taken.
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Figure 1. Laboratory data, drug history and clinical course of the case
Table 1. Laboratory data
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