Citation Information :
Kumar K, Srinivas A, Kumar D. Intense Pruritus and Intractable Cough in a Child with Hepatitis A Infection: Response to Naltrexone. Ann Pediatr Gastroenterol Hepatol 2024; 6 (2):15-16.
Prolonged cholestasis is a rare distinct complication of hepatitis A infection, and its association with intense refractory cough is even rarer. We present a case of acute viral hepatitis, whose liver function test showed a very high level of direct bilirubinemia with disabling pruritus and dry cough, refractory to standard conventional treatment. Treatment with naltrexone led to complete recovery in the patient. This observation in our patient strongly supports the hypothesis that increased central opioidergic tone may be a component behind the pathophysiology of prolonged and intense cholestasis, which may cause refractory dry cough by modulating the central cough reflex.
WHO, 2010. The Global Prevalence of Hepatitis A Virus Infection and Susceptibility: A Systematic Review. Available from http://apps.who.int/iris/bitstream/10665/70180/1/WHO_IVB_10.01_eng.pdf. [Last accessed May, 2018].
Aggarwal R, Goel A. Hepatitis A: epidemiology in resource-poor countries. Curr Opin Infect Dis 2015;28(5):488–496. DOI: 10.1097/QCO.0000000000000188
Migueres M, Lhomme S, Izopet J. Hepatitis A: epidemiology, high-risk groups, prevention and research on antiviral treatment. Viruses 2021;13(10):1900. DOI: 10.3390/v13101900
Raymond S, Koff MD. Handbook of Liver Disease, 3rd edition. Philadelphia: Elsevier Health Sciences; 2012.
Pullukçu H, Kahraman H, Yamazhan T, et al. Use of steroids for prolonged cholestasis secondary to acute hepatitis A infection. J Microbiol Infect Dis 2014;4(4):162–164. DOI: 10.5799/ahinjs.02.2014.04.0161
Chatila R, Bergasa NV, Lagarde S, et al. Intractable cough and abnormal pulmonary function in benign recurrent intrahepatic cholestasis. Am J Gastroenterol 1996;91(10):2215–2219.
Jones EA, Bergasa NV. The pruritus of cholestasis. Hepatology 1999;29(4):1003–1006. DOI: 10.1002/hep.510290450
Jones EA, Dekker LR. Florid opioid withdrawal-like reaction precipitated by naltrexone in a patient with chronic cholestasis. Gastroenterology 2000;118(2):431–432. DOI: 10.1016/s0016-5085(00)70225-3
Imam MH, Gossard AA, Sinakos E, et al. Pathogenesis and management of pruritus in cholestatic liver disease. J Gastroenterol Hepatol 2012;27(7):1150–1158. DOI: 10.1111/j.1440-1746.2012.07109.x
Phan NQ, Bernhard JD, Luger TA, et al. Antipruritic treatment with systemic μ-opioid receptor antagonists: a review. J Am Acad Dermatol 2010;63(4):680–688. DOI: 10.1016/j.jaad.2009.08.052
Malekzad F, Arbabi M, Mohtasham N, et al. Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study. J Eur Acad Dermatol Venereol 2009;23(8):948–950. DOI: 10.1111/j.1468-3083.2009.03129.x
Bergasa NV, Alling DW, Talbot TL, et al. Effects of naloxone infusions in patients with the pruritus of cholestasis. A double-blind, randomized, controlled trial. Ann Intern Med 1995;123(3):161–167. DOI: 10.7326/0003-4819-123-3-199508010-00001
Stancil SL, Abdel-Rahman S, Wagner J. Developmental considerations for the use of naltrexone in children and adolescents. J Pediatr Pharmacol Ther 2021;26(7):675–695. DOI: 10.5863/1551-6776-26.7.675
