Massive Pulmonary Bleed from Undiagnosed Hepatitis C Infection

A 14 year-old previously healthy female patient presented with back pain, halitosis, and hemoccult positive stool.She was ultimately diagnosed with Takayasu’s Vasculitis and thrombo-angiitis vasculitis as well as a post-mortemdiagnosis of Hepatitis C. The two vasculitides created a pulmonary arterial-esophageal fistula with a necrotic areaand a ruptured pulmonary artery, which led to the patient’s death. Further discussion with the familyindicated thatthey were unaware of the patient’s Hepatitis C status and they denied any risk factors the patient may have had thatlead to Hepatitis C infection. Obtaining a history in pediatric patients is often limited by what the family knows anddiscloses, but when a patient presents with elevated inflammatory markers, halitosis, and hemoccult-positive stool,an esophageal fistula should be considered in one’s differential diagnosis.