Hepatitis in Acquired Rubella Infection in Children

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Abstract
Sir.—Although congenital rubella frequently is accompanied by hepatocellular disease,1 liver involvement in acute acquired rubella, to our knowledge, has not been recognized.2,3 Recently, Zeldis et al4 reported a case of rubella accompanied by serum aminotransferase level elevations in an adult. We determined liver-derived serum enzyme levels in pediatric patients with rubella to clarify the incidence and clinical features of liver involvement. Early in 1987, a rubella epidemic occurred in Japan. In this study, we analyzed 241 patients who were serologically confirmed to have rubella by a hemagglutination inhibition test. At the first visit, we measured serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and its isoenzymes, alkaline phosphatase (AP), and γ-glutamyltransferase (GGT) levels. We arbitrarily defined liver dysfunction as an elevation of ALT level over 100 U/L. Normal reference interval levels are AST, 20 to 50 U/L; ALT, 10 to 40 U/L; and LDH,

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