Clinically Diagnosed Decompensated Chronic Liver Disease With Suspected Portal Hypertension in a One‐Year‐Old Infant: Diagnostic Challenges in a Resource‐Limited Setting

ABSTRACT

Chronic liver disease in infancy is uncommon, diagnostically demanding, and rarely reported from sub‐Saharan Africa, where advanced hepatologic evaluation is seldom accessible. We describe a one‐year‐old boy from rural Somaliland who presented with a two‐week 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 g/dL), thrombocytopenia (130 × 10 ⁹ /L), conjugated hyperbilirubinemia (total 2.45 mg/dL, direct 1.69 mg/dL), severe hypoalbuminemia (albumin 1.8 g/dL) and marked coagulopathy (INR 3.0). Grayscale ultrasonography showed an irregular hepatic surface, splenomegaly and large‐volume 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‐term improvement, with a 4 cm reduction in abdominal girth, a rise in hemoglobin to 8.3 g/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—fractionated bilirubin, gamma‐glutamyl transferase, coagulation profile, albumin, hepatitis serology, diagnostic paracentesis and grayscale ultrasonography—for infants with suspected chronic liver disease in low‐resource settings.