Acute Hepatitis A With Polyserositis and Acalculous Cholecystitis in an Adult: A Case Report

Hepatitis A virus (HAV) infection in adults is usually self-limited, yet atypical extrahepatic features may complicate the course. We report a 20-year-old male with fever, jaundice, and moderate ascites. Evaluation showed marked hepatocellular injury with direct-predominant hyperbilirubinemia and positive HAV IgM. Imaging demonstrated hepatosplenomegaly, bilateral pleural effusions, and gallbladder wall edema without calculi, consistent with acalculous cholecystitis; there was no encephalopathy. He received conservative management. After initial improvement, a transient mid-course bilirubin rebound occurred, compatible with self-limited intrahepatic cholestasis, followed by steady recovery. By three months, liver tests had normalized; HAV IgM remained weakly positive, and HAV IgG seroconversion was documented. This case highlights that adult HAV can rarely present with polyserositis and acalculous cholecystitis yet resolve without invasive therapy, and that cholestatic flares and delayed serologic evolution may accompany otherwise benign convalescence.