Pleural effusion – An unusual cause

Nagarajan, Ponnurangam; Palaniyadi, A; M, Sathyamoorthi; R, Sasitharan; Shuba, S; Sivaraman, Rajakumar Padur; Jx, Scott

doi:10.4066/amj.2012.1024

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…13 Hepatitis A infection-related pleural effusion is a rare extrahepatic manifestation in children. 14 Hepatitis A infection associated with pleural effusion was reported usually on the right side of the lung. 9,11,12 But bilateral effusion has also been documented.…”

Section: Discussionmentioning

confidence: 99%

“…Documented case reports of HAV infection with pleural effusions showed that the presence of effusion with HAV infection did not signify poor outcome and it resolves with supportive treatment alone. 6,8,10,11,14,[17][18][19] Though the patient had nearly normal serum bilirubin (1.5mg/dl) and the liver enzymes were highly elevated especially the alkaline phosphatase which was 1000 mg/ dl, but since it is nonspecific to the liver it may not be exclusively signal of liver damage and also the reference range for his age is 93-309 that means 3 to5 times elevated. However, the other enzymes specific to the liver like alanine amino transaminase were also highly elevated.…”

Section: Discussionmentioning

confidence: 99%

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<p>Pleural Effusion Associated with Anicteric Hepatitis A Virus Infection – Unusual Manifestation of a Common Disease: A Case Report</p>

Hadgu

Alemu

2020

PHMT

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Background: Hepatitis A infection is common in children and often presents with mild hepatic disease. The clinical manifestations of hepatitis A virus are usually related to liver damage but sometimes extrahepatic manifestations may occur. Case Presentation: We present a case of four-year-and eight-month-old male child with anicteric hepatitis A infection associated with a pleural effusion. The patient presented with abdominal pain, low-grade fever, loss of appetite, and vomiting of ten days duration. On examination, there was dullness and decreased air entry on the lower third of the lung field bilaterally and hepatomegaly of 6 cm below the costal margin. Ultrasonography revealed mild ascites, hepatosplenomegaly, and small bilateral pleural effusion. Immunoglobulin M anti-hepatitis A virus serology was positive. He was managed with supportive treatment and fully recovered after a month of follow-up. This case is reported to emphasize that hepatitis A infection should be considered in the differential diagnosis of pleural effusion in a patient with acute hepatitis even in the absence of jaundice. This is the first case of anicteric hepatitis A infection complicated with pleural effusion in children. Conclusion:This report suggests that pleural effusion can be associated with anicteric hepatitis A infection and should be included in the differential diagnosis of pleural effusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

<p>Pleural Effusion Associated with Anicteric Hepatitis A Virus Infection – Unusual Manifestation of a Common Disease: A Case Report</p>

Hadgu

Alemu

2020

PHMT

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Hepatitis A Associated with Chylothorax: An Uncommon Presentation of a Common Infection

et al. 2015

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Extra-hepatic manifestations have seldom been described with hepatitis A, which usually manifests as mild hepatic dysfunction. We report a 3-year-old boy presenting with 3 days of fever, vomiting, abdominal distention and scleral icterus. On examination, he had tachypnea, hepatosplenomegaly, ascites and right-sided pleural effusion. A diagnostic pleural tap yielded a milky, lymphocyte-predominant exudative aspirate, with pleural fluid triglycerides of 175 mg/dl, suggestive of chylothorax. Serology for anti-HAV IgM was positive in both blood and pleural fluid. The massive effusion causing collapse of the underlying lung was drained by tube thoracostomy, which was followed by complete resolution within 2 weeks. This is the first reported case of chylothorax associated with hepatitis A infection. This report highlights that pleural effusion associated with hepatitis A infection is usually a benign, self-limiting condition which should be considered in the differential diagnosis of pleural effusion or chylothorax in a patient with acute viral hepatitis.

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Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

et al. 2022

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Introduction Hepatitis A virus infections are mostly asymptomatic or mildly symptomatic, and generally this disease has a benign course and resolves spontaneously. However, intrahepatic and rarer extrahepatic manifestations can complicate typical cases of acute hepatitis. Pleural effusion is an extremely rare extrahepatic entity with 20 cases reported in literature. Case presentation We report herein a recent case of both pleural effusion and ascites accompanying hepatitis A infection in a 5-year-old middle eastern child, diagnosed using serological testing and imaging studies, who was treated with supportive management with full resolution after 2 weeks. In addition, we review available literature regarding hepatitis A virus associated with pleural effusion using PubMed and summarize all reported cases in a comprehensive table. Results Literature contains 20 reported cases of serology-confirmed hepatitis A virus presenting with pleural effusion, most in the pediatric population with average age at presentation of 9 years 8 months. The majority of reported patients had right-sided pleural effusion (50%) or bilateral effusion (45%), while only 5% presented with pleural effusion on the left side. Hepatomegaly and ascites occurred concurrently in 80% and 70% respectively. Supportive treatment without invasive procedures (except one chylothorax case) yielded complete recovery in 95% of cases, while only one case progressed to fulminant liver failure followed by death. Conclusion Acute hepatitis A virus rarely presents with pleural effusion, usually following a benign course with spontaneous resolution in most patients. Pleural effusion does not change the prognosis or require any invasive treatment. Thus, further invasive procedures are not recommended and would only complicate this self-resolving benign condition.

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Pleural effusion – An unusual cause

Cited by 6 publications

References 7 publications

<p>Pleural Effusion Associated with Anicteric Hepatitis A Virus Infection – Unusual Manifestation of a Common Disease: A Case Report</p>

<p>Pleural Effusion Associated with Anicteric Hepatitis A Virus Infection – Unusual Manifestation of a Common Disease: A Case Report</p>

Hepatitis A Associated with Chylothorax: An Uncommon Presentation of a Common Infection

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

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