A Rare Presentation of Hepatitis A Infection with Extrahepatic Manifestations

Abstract

Hepatitis A has a variety of associated extrahepatic manifestations that clinicians should be aware of for early diagnosis and treatment. We report a unique case of hepatitis A presenting with multiple extrahepatic manifestations not previously described in a single patient. A 34-year-old male presented with sudden onset of left sided facial pain, swelling, and skin rash, with diffuse body pains and muscle weakness, and was found to be positive for hepatitis A immunoglobulin M (IgM). He was initially started on antibiotics for concerns of bacterial parotitis but did not show any improvement. A punch biopsy of his mandibular rash and swelling was done which showed lymphohistiocytic infiltration with a few eosinophils. A trial of prednisone resulted in improvement of his symptoms. Clinicians should be aware to look for hepatitis A infection in a patient with atypical clinical picture causing a widespread systemic inflammatory response. Treatment with prednisone may result in resolution.

Acute bilateral granulomatous anterior uveitis as an extra-hepatic manifestation of hepatitis A virus (HAV) infection: A case report

“…noted that direct invasion of HAV into the kidney tissues as well as immune-related mechanisms may lead to ARF. (11) In our literature review, previous reports of ophthalmic manifestations associated with HAV infection were not found. Stangos et al reported a case of multiple evanescent white dot syndrome (an in ammatory chorioretinal disorder) 10 days after receiving simultaneous formalin-inactivated HAV and live-attenuated yellow fever vaccine.…”

“…Bhatt at el. reported a 34 year-old man with acute parotitis and facial skin rash as the manifestations of HAV infection 6 days prior to any hepatic presentations (11) These ndings suggest that extra-hepatic manifestations of HAV infection may occur before (during incubation period) or after the presentation of systemic and hepatic signs secondary to deposition of circulating immune-complex in various organs.…”

“…In these conditions, deposition of the immune-complex in various organs such as the skin, joints, kidneys, and muscles leads to immune system activation. (6,(10)(11)(12) Bhatt et el. noted that direct invasion of HAV into the kidney tissues as well as immune-related mechanisms may lead to ARF.…”

Aseptic Meningitis and Infection-Associated Hemophagocytic Lymphohistiocytosis—Rare Complications of Hepatitis A Virus İnfection

“…Extrahepatic involvement is rare unlike in hepatitis B or hepatitis C infection. 2 Extrahepatic manifestations may include acute kidney injury due to immune complex glomerulonephritis, 2 urticarial and maculopapular rash, polymyositis, arthralgias, suppurative parotitis, 3,4 acute pancreatitis, acute cholecystitis, and bone marrow suppression leading to cytopenias, which can be seen in both the prodrome phase and acute infection. 1,2 Hepatitis A virus (HAV) rarely involves the central nervous system.…”

“…2 Extrahepatic manifestations may include acute kidney injury due to immune complex glomerulonephritis, 2 urticarial and maculopapular rash, polymyositis, arthralgias, suppurative parotitis, 3,4 acute pancreatitis, acute cholecystitis, and bone marrow suppression leading to cytopenias, which can be seen in both the prodrome phase and acute infection. 1,2 Hepatitis A virus (HAV) rarely involves the central nervous system. 4 Hemophagocytic lymphohistiocytosis (HLH) is a disorder of uncontrolled, pathological activation of the immune system leading to extreme hyperinflammation.…”