Unusual presentation of viral hepatitis A: a study of 40 cases

Abstract

Viral hepatitis A (VHA) is usually asymptomatic in children. In more than 90% of cases, symptomatic forms are classic and have rapid favorable outcome. Unusual presentations including atypical and severe forms are uncommon. The aim of this study was to describe clinical characteristics and outcome of atypical and severe presentations of HVA. We included in this retrospective study 40 patients aged less than 16 years admitted between June 1995 and December 2014 for acute liver failure, prolonged cholestasis, relapse, extra hepatic manifestations or autoimmune hepatitis. Results: Thirty-one patients have acute liver failure complicated with hepatic encephalopathy in 12 cases. Mortality rate was 19.4%. A prothrombin time below 21% and a bilirubin level above 300 µmol/l were associated to a poor prognosis. An VHA had revealed autoimmune hepatitis in 2 patients. Conclusion: Fulminant VHA is rare and associated to a high mortality. In endemic areas, HAV must be eliminated in all patients with prolonged or biphasic cholestasis, alithiasic cholecystitis and autoimmune hepatitis.