To the Editor.—

I write to add several comments about the recent report in Pediatrics on 4 cases of West Nile virus (WNV) infection in children. With regard to the first patient, the authors comment numerous times about the unusual presentation of a “fulminant hepatitis.” In addition, they use the term “hepatic failure” to describe the marked elevation of transaminases along with a mild coagulopathy. Based on my careful reading, I conclude that this patient had neither fulminant hepatitis nor hepatic failure. Furthermore, I think the assertion that this child's liver injury is causally related to WNV is misleading.

Among hepatologists, the most widely accepted definition of fulminant hepatic failure includes the onset of hepatic encephalopathy <8 weeks after the beginning of liver disease. Failure of the liver and loss of hepatocyte function results in the inability to remove neurotoxins and synthesize vital proteins that are needed to...

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