{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:14:02Z","timestamp":1788156842771,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Chronic liver disease in infancy is uncommon, diagnostically demanding, and rarely reported from sub\u2010Saharan Africa, where advanced hepatologic evaluation is seldom accessible. We describe a one\u2010year\u2010old boy from rural Somaliland who presented with a two\u2010week history of progressive abdominal distension, followed by jaundice, hematemesis and bloody diarrhea. Examination showed wasting, deep scleral icterus, tense ascites, caput medusae and splenomegaly. Investigations demonstrated severe anemia (hemoglobin 3.8\u2009g\/dL), thrombocytopenia (130\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L), conjugated hyperbilirubinemia (total 2.45\u2009mg\/dL, direct 1.69\u2009mg\/dL), severe hypoalbuminemia (albumin 1.8\u2009g\/dL) and marked coagulopathy (INR 3.0). Grayscale ultrasonography showed an irregular hepatic surface, splenomegaly and large\u2010volume ascites. Doppler ultrasonography, upper gastrointestinal endoscopy, liver biopsy, elastography, cytomegalovirus IgM and polymerase chain reaction testing, and metabolic and genetic studies were unavailable, and an isolated positive cytomegalovirus IgG was considered inconclusive. A clinical diagnosis of decompensated chronic liver disease with suspected portal hypertension was therefore made without an established etiology. Whole blood transfusion, intravenous albumin, vitamin K, sodium restriction and combined spironolactone and furosemide produced short\u2010term improvement, with a 4\u2009cm reduction in abdominal girth, a rise in hemoglobin to 8.3\u2009g\/dL and cessation of bleeding. This case shows that a defensible syndromic diagnosis and effective stabilization are achievable without advanced testing, and supports adoption of a defined minimum diagnostic dataset\u2014fractionated bilirubin, gamma\u2010glutamyl transferase, coagulation profile, albumin, hepatitis serology, diagnostic paracentesis and grayscale ultrasonography\u2014for infants with suspected chronic liver disease in low\u2010resource settings.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.73343","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:50:06Z","timestamp":1787201406000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinically Diagnosed Decompensated Chronic Liver Disease With Suspected Portal Hypertension in a One\u2010Year\u2010Old Infant: Diagnostic Challenges in a Resource\u2010Limited Setting"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9028-8216","authenticated-orcid":false,"given":"Khadar Jama","family":"Ibrahim","sequence":"first","affiliation":[{"name":"College of Health Sciences, School of Medicine and Surgery Amoud University  Borama Somaliland"},{"name":"Emergency Department Hargeisa Group Hospital  Hargeisa Somaliland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdisamed Mohamoud H.","family":"Ali","sequence":"additional","affiliation":[{"name":"College of Health Sciences, School of Medicine and Surgery Amoud University  Borama Somaliland"},{"name":"Emergency Department Hargeisa Group Hospital  Hargeisa Somaliland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9658-4032","authenticated-orcid":false,"given":"Nouradin Ibrahim","family":"Omer","sequence":"additional","affiliation":[{"name":"College of Health Sciences, School of Medicine and Surgery Amoud University  Borama Somaliland"},{"name":"Emergency Department Hargeisa Group Hospital  Hargeisa Somaliland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer Ali","family":"Elmi","sequence":"additional","affiliation":[{"name":"College of Medicine and Surgery, University of Hargeisa  Hargeisa Somaliland"},{"name":"Department of Pediatrics Hargeisa Group Hospital  Hargeisa Somaliland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"issue":"8","key":"e_1_2_16_2_1","first-page":"812","article-title":"Systemic Complications Secondary to Chronic Liver Disease","volume":"90","author":"Mannion R.","year":"2023","journal-title":"Indian Journal of 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