Urticaria and Elevated Liver Enzymes in Infants

Urticaria and elevated liver enzymes?

Hello, doctor! I have a three-month-old baby boy at home who, on October 1, 2016, presented with a runny nose and slight lethargy.
The clinic prescribed cyproheptadine, reason tablets, biofermin, and mirate liquid, which were stopped on October 5.
On October 7, we sought medical attention for a diaper rash complicated by a fungal infection, and the doctor prescribed a combination ointment (triamcinolone acetonide, neomycin, gramicidin, nystatin) and administered the pneumococcal vaccine on the same day.
From October 8 to 9, the redness from the diaper rash around the anus improved after applying the ointment, but the rash spread to the thighs and abdomen, with small red spots appearing on the palms and soles.
On October 11, a sudden widespread rash resembling urticaria appeared on the chest and abdomen, leading to an emergency visit that night for antihistamine injection and blood tests (white blood cell count normal, liver enzymes at 52), resulting in hospitalization.
By October 12, the acute rash had subsided, leaving only small red spots.
On October 14, liver enzymes were at 100 (with no fever and normal activity during this period).

I have the following questions:
1.
Can urticaria cause elevated liver enzymes, or could there be another underlying condition?
2.
We have a dog at home; is there a high risk of toxoplasmosis infection? We did not have this test during pregnancy.

3.
What tests can we request from the doctor to help determine the cause of these symptoms?

Zhang Xiansheng, 0~9 year old female. Ask Date: 2016/10/16

Dr. Xiao Kaiwen reply Pediatrics

1.
Urticaria generally does not cause liver dysfunction.
There are many potential causes for liver dysfunction (including infectious, drug-induced, chemical, autoimmune, metabolic, etc.), some of which may resolve on their own, while others can be relatively severe.
Please discuss this with your attending physician.

2.
The definitive host for Toxoplasma gondii is felines, not canines, and the clinical symptoms of your child do not resemble those of a Toxoplasma infection.
3.
As mentioned in point 1, the necessary tests and examinations vary depending on each potential cause.
A comprehensive assessment should be made based on other clinical symptoms, laboratory reports, and physical examinations to determine which tests are needed.
Therefore, please consult with your attending physician.

Reply Date: 2016/10/16

More Info

Understanding the relationship between urticaria (hives) and elevated liver enzymes in infants can be complex, especially in the context of your three-month-old son who has experienced a series of health issues. Let's break down your questions and provide a comprehensive understanding of the situation.

1. Can urticaria cause elevated liver enzymes?
Urticaria itself is primarily an allergic reaction characterized by raised, itchy welts on the skin. It is typically triggered by allergens, infections, or other stimuli. While urticaria is not directly known to cause elevated liver enzymes, the underlying causes of urticaria, such as infections or allergic reactions, could potentially lead to liver stress or inflammation. In infants, elevated liver enzymes can be indicative of various conditions, including viral infections, metabolic disorders, or even drug reactions. In your case, the elevated liver enzymes (from 52 to 100) following the onset of urticaria could suggest that there is an underlying issue that needs to be addressed, rather than the urticaria itself being the direct cause.

2. Is there a high risk of toxoplasmosis infection due to having a dog at home?
Toxoplasmosis is caused by the parasite Toxoplasma gondii, which can be transmitted through contact with cat feces, undercooked meat, or contaminated food and water. While dogs can carry the parasite, they are not the primary hosts; cats are. If you did not have any exposure to cat feces during your pregnancy and your dog is healthy and well-cared for, the risk of transmission to your infant is relatively low. However, if there are concerns about potential exposure, it may be worth discussing with your pediatrician or a specialist in infectious diseases.

3. What tests can be done to determine the cause of the symptoms?
Given the symptoms and the elevated liver enzymes, several tests can be considered to help identify the underlying cause:
- Liver Function Tests (LFTs): To assess the extent of liver involvement and monitor enzyme levels over time.

- Viral Hepatitis Panel: To rule out viral hepatitis, which can cause elevated liver enzymes in infants.

- Autoimmune Panel: To check for autoimmune conditions that might affect the liver.

- Metabolic Screening: To identify any metabolic disorders that could lead to liver dysfunction.

- Allergy Testing: If urticaria is suspected to be allergic in nature, skin prick tests or specific IgE tests can help identify potential allergens.

- Imaging Studies: An abdominal ultrasound may be useful to visualize the liver and assess for any structural abnormalities.

In conclusion, while urticaria itself is unlikely to be the direct cause of elevated liver enzymes, it is essential to investigate further to rule out other underlying conditions. Close monitoring and collaboration with your healthcare provider are crucial in managing your infant's health. Regular follow-ups and appropriate testing will help ensure that any potential issues are identified and treated promptly. Always consult with your pediatrician or a pediatric gastroenterologist for tailored advice and management strategies based on your child's specific situation.

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