Atypical manifestations of acute viral hepatitis A in children in Bangladesh: Are these really uncommon?

Benign polyserositis and acalculous cholecystitis, a rare presentation of acute viral hepatitis A and E co-infection

“…Fulminant hepatic failure occurs in <1% of children infected with hepatitis A and 0.5–4% with hepatitis E. 3,8 Co-infection with both viruses may lead to serious complications and increased mortality in both children and adults. 9 Extra-hepatic complications due to hepatitis A occur in 6–8% of patients 1,3 while there are only few case reports and case series of extra-hepatic manifestations in patients with hepatitis E. Manifestations associated with hepatitis A include acalculous cholecystitis, cryoglobinaemia, cutaneous vasculitis, arthralgia, Guillane-Barre syndrome, transverse myelitis, haemophagocytic syndrome, nephrotic syndrome, pleural effusion, reactive arthritis and Gianotti-Crosti syndrome. 10 Extra-hepatic manifestations associated with hepatitis E include acute pancreatitis, Guillain-Barre syndrome, neuralgic amyotrophy, haemolytic anaemia, severe thrombocytopenia, glomerulonephritis, and mixed cryoglobinaemia.…”

“…10 Extra-hepatic manifestations associated with hepatitis E include acute pancreatitis, Guillain-Barre syndrome, neuralgic amyotrophy, haemolytic anaemia, severe thrombocytopenia, glomerulonephritis, and mixed cryoglobinaemia. 11 Pleural effusion, found in only 0.1–2% of children 1,2 usually undergoes spontaneous resolution. 12,13 The exact pathogenesis of pleural effusion and ascites with acute viral hepatitis is not known; possible mechanisms include: direct pleural viral invasion as suggested by hepatitis virus ribonucleic acid by polymerase chain reaction in the pleural fluid, 12 immune complex deposition in the pleura, reactive inflammation, decrease in plasma oncotic pressure leading to plasma leak, transient portal vein hypertension or lymphatic pressure due to compression by the hepatic sinusoids, small diaphragmatic defects or passage in diaphragmatic lymphatics.…”

“…Pleural effusion has been reported in 0.1-2% of children with acute viral hepatitis. 1,2 Pleural effusion with hepatitis A and E co-infection has been rarely reported (in a 4-year-old child and in a 32-year-old adult). 3,4 We report a case of pleural effusion, ascites and acalculous cholecystitis with hepatitis A and E co-infection in a child.…”

Author’s reply to comment on article: Atypical manifestations of acute viral hepatitis A in children in Bangladesh: Are these really uncommon?

“…[1]. We concluded that atypical manifestations such as prolonged cholestasis and ascites are not uncommon in children with acute viral hepatitis A (AVH-A) in developing countries and seen in almost one-sixth of patients [1]. We also agree that the mentioned problems on cholestasis are not uncommon and might be a common problem in patients in many settings as it might be a result of a concurrent disorder like hemolysis [2].…”

Undiagnosed Wilson Disease Presented as Liver Failure after Hepatitis A Virus Super infection

“…HAV infection occurs throughout the world and incidence of HAV infection globally is 1.5 million per year. 1 It is more prevalent in developing countries. In Asia, countries are divided into low, moderate, or high endemic regions for HAV infection.…”