[Biphasic viral hepatitis "A" associated with autoimmune phenomena]

Acute hepatitis A virus infection (HAV) is a benign, self limited disease with infrequent extrahepatic features unlike the hepatitis B or the nonA-nonB virus infection. We describe the case of a 37 year old white woman with HAV who had a relapse with a second elevation of the alanine aminotransferase level together with joint pain, skin lesions, angioneurotic edema, and autoantibodies (ANA, anti smooth muscle, antiparietal gastric cells). The liver biopsy showed piecemeal and early bridging necrosis. She had a rapid reversal of her clinical, biochemical and histological abnormalities. As far as we known, this is the first reported case of autoantibodies or angioneurotic edema associated with HAV. We comment on the pathogenesis of this rare association.