{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:40:09Z","timestamp":1756312809601,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,4,6]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>Multisystem inflammatory syndrome in children (MIS-C) is a known complication of COVID-19. There is still limited knowledge about this condition. Here, we report the case of a previously healthy toddler boy, who presented with acute liver failure and duodenal lesions resulting in severe haematemesis and haemorrhagic shock, requiring intensive care unit care. The patient had persistent transaminitis, a deranged coagulation profile, inflammatory markers were elevated, and laboratory tests were negative for common infectious hepatitis aetiologies as well as COVID-19 Reverse transcription polymerase chain reaction. His COVID-19 antibody was reactive. Upper gastrointestinal endoscopy revealed a Forrest grade III duodenal ulcer. Looking into the constellation of symptoms and laboratory findings a confirmed diagnosis of acute viral hepatitis caused by MIS-C was made. Hence, he was given intravenous methylprednisolone along with intravenous immunoglobulins, after which he improved clinically and transaminitis resolved. The patient was discharged on clinical improvement and was doing fine on follow-up up to 6 months.<\/jats:p>","DOI":"10.1136\/bcr-2023-256643","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T13:40:22Z","timestamp":1720100422000},"page":"e256643","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute liver failure with a massive upper GI bleed meeting the criteria of MIS-C"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8984-846X","authenticated-orcid":false,"given":"Anshika","family":"Mishra","sequence":"first","affiliation":[{"name":"Pediatrics, King George's Medical University, Lucknow, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaya","family":"Gupta","sequence":"additional","affiliation":[{"name":"Pediatrics, King George's Medical University, Lucknow, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Areesha","family":"Alam","sequence":"additional","affiliation":[{"name":"Pediatrics, King George's Medical University, Lucknow, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5309-4336","authenticated-orcid":false,"given":"Sanjeev Kumar","family":"Verma","sequence":"additional","affiliation":[{"name":"Pediatrics, King George's Medical University, Lucknow, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"2025082709004711000_17.7.e256643.1","unstructured":"Center for disease control and prevention, center for preparedness and response: Multisystem inflammatory syndrome in children (MIS-C) associated with Coronavirus disease 2019 (COVID-19), clinician outreach and communication (COCA) Webinar. Available: https:\/\/emergency.cdc.gov\/coca\/calls\/2020\/callinfo_051920.asp?deliveryName=USCDC_1052-DM28623 [Accessed 19 May 2020]."},{"key":"2025082709004711000_17.7.e256643.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021756"},{"key":"2025082709004711000_17.7.e256643.3","unstructured":"Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 Geneva: World Health Organization, Available: https:\/\/www.who.int\/news-room\/commentaries\/detail\/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 [Accessed 19 May 2023]."},{"key":"2025082709004711000_17.7.e256643.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.12.003"},{"key":"2025082709004711000_17.7.e256643.5","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/7604939","article-title":"Frequency of hepatobiliary manifestations and concomitant liver disease in inflammatory bowel disease patients","volume":"2019","author":"Silva","year":"2019","journal-title":"Biomed Res Int"},{"key":"2025082709004711000_17.7.e256643.6","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/s41572-018-0018-3","article-title":"Wilson disease","volume":"4","author":"Cz\u0142onkowska","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"2025082709004711000_17.7.e256643.7","first-page":"599","article-title":"Usefulness of brushing Urease test for diagnosis of Helicobacter Pylori infection","volume":"30","author":"Trevisani","year":"1998","journal-title":"Ital J Gastroenterol Hepatol"},{"key":"2025082709004711000_17.7.e256643.8","unstructured":"New York City COVID cases on March 17th 2020. New City Department of health COVID-19; 2020."},{"key":"2025082709004711000_17.7.e256643.9","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1002\/hep.31526","article-title":"Acute hepatitis is a prominent presentation of the Multisystem inflammatory syndrome in children: a single-center report","volume":"72","author":"Cantor","year":"2020","journal-title":"Hepatology"},{"key":"2025082709004711000_17.7.e256643.10","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2022.896903","article-title":"Case report: MIS-C with prominent hepatic and Pancreatic involvement in a vaccinated adolescent - A critical reasoning","volume":"10","author":"Consolini","year":"2022","journal-title":"Front Pediatr"},{"key":"2025082709004711000_17.7.e256643.11","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1111\/liv.14470","article-title":"COVID-19 and liver disease","volume":"40","author":"Sun","year":"2020","journal-title":"Liver Int"},{"key":"2025082709004711000_17.7.e256643.12","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00183.2020"},{"key":"2025082709004711000_17.7.e256643.13","doi-asserted-by":"crossref","first-page":"457","DOI":"10.32641\/rchped.v91i3.1284","article-title":"Falla Hep\u00e1tica Aguda en Pediatr\u00eda [pediatric acute liver failure]","volume":"91","author":"Cardenas","year":"2020","journal-title":"Rev Chil Pediatr"},{"key":"2025082709004711000_17.7.e256643.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgast-2020-000578","article-title":"Gastrointestinal Mucosal damage in patients with COVID-19 undergoing Endoscopy: an international Multicentre study BMJ","volume":"8","author":"Vanella","year":"2021","journal-title":"BMJ Open Gastroenterol"},{"key":"2025082709004711000_17.7.e256643.15","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-320953"},{"key":"2025082709004711000_17.7.e256643.16","unstructured":"Wadman M , Couzin-Frankel J , Kaiser J , et al . How does Coronavirus kill. Clinicians trace a ferocious rampage through the body, from brain to toes. 2020;6:45."},{"key":"2025082709004711000_17.7.e256643.17","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jama.2021.0694","article-title":"French COVID-19 Paediatric inflammation consortium. Association of intravenous Immunoglobulins plus methylprednisolone vs Immunoglobulins alone with course of fever in Multisystem inflammatory syndrome in children","volume":"325","author":"Ouldali","year":"2021","journal-title":"JAMA"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256643","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:00:56Z","timestamp":1756310456000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":17,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,4]]},"published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1136\/bcr-2023-256643"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256643","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}