Rare but real: Unusual manifestations of hepatitis A

Area of Science:

• Pediatrics
• Infectious Diseases
• Hepatology

Background:

• Hepatitis A virus (HAV) infection is typically self-limiting in children, often presenting with jaundice.
• Rarely, HAV can lead to extra-hepatic manifestations, affecting organs beyond the liver.
• Cardiac and pancreatic involvement are uncommon but serious complications of HAV.

Purpose of the Study:

• To report two pediatric cases of Hepatitis A with unusual extra-hepatic manifestations.
• To emphasize the importance of recognizing atypical presentations of HAV infection in children.
• To advocate for the integration of Hepatitis A vaccination into India's national immunization program.

Main Methods:

• Case report of two pediatric patients diagnosed with Hepatitis A.
• Clinical presentation, diagnostic workup including electrocardiogram and laboratory tests, and imaging findings were analyzed.
• Management and clinical outcomes were documented.

Main Results:

• Case 1: A 6-year-old boy presented with lethargy, vomiting, bradycardia, complete heart block, and pleural effusion.
• Case 2: A 10-year-old boy presented with abdominal pain, elevated pancreatic enzymes, and imaging consistent with pancreatitis.
• Both patients showed improvement with conservative management.

Conclusions:

• These cases highlight the spectrum of rare systemic complications of Hepatitis A in children.
• Prompt recognition of atypical symptoms is vital for appropriate patient management.
• Hepatitis A vaccination is essential for preventing severe outcomes and should be integrated into national immunization schedules.