PMID- 36258990
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221020
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 9
DP  - 2022 Sep
TI  - Rare Diagnostic and Clinical Manifestations in an Acute Hepatitis A Infection: A 
      Case Report.
PG  - e29194
LID - 10.7759/cureus.29194 [doi]
LID - e29194
AB  - The hepatitis A virus (HAV) is a common cause of infectious hepatitis worldwide. 
      In adults, clinical manifestations typically involve fever, nausea/vomiting, 
      fatigue, abdominal pain, and jaundice, although rarer manifestations may be 
      observed. Acute hepatitis A infection is detected via anti-HAV IgM antibodies, 
      which are present in almost all patients at symptom onset. In this case, we 
      present a patient who not only tested negative for acute HAV infection at symptom 
      onset, but also presented with uncommon, extrahepatic manifestations including 
      maculopapular skin rash and polyarthralgia. Wariness of such a presentation can 
      facilitate the timely diagnosis of atypical cases of HAV infection. We report the 
      case of a 51-year-old man who presented with fever, abdominal pain, headaches, 
      and diarrhea for one week with elevated liver enzymes and leukocytosis. Workup 
      consisting of viral hepatitis panels, various infectious studies, and 
      rheumatologic antibody titers did not initially reveal an etiology for the 
      patient's presentation. Computed tomography (CT) abdomen and pelvis, abdominal 
      ultrasound, magnetic resonance cholangiopancreatography (MRCP), and hepatobiliary 
      iminodiacetic acid (HIDA) scan did not reveal acute pathology. The patient's 
      symptoms worsened over the following days, and he additionally developed 
      bilateral wrist pain, digital arthralgias, paraspinal back pain, diffuse muscular 
      weakness, and a pruritic maculopapular rash affecting the flanks and extremities. 
      Eventually, viral hepatitis studies were repeated which revealed elevated levels 
      of anti-HAV IgM antibodies, indicating acute hepatitis A infection. The patient 
      was treated supportively while hospitalized with subsequent improvement of 
      symptoms and lab abnormalities. Since discharge, the patient had not experienced 
      persistent sequelae of the disease. This case of acute viral hepatitis A 
      infection is notable for two reasons: (1) the patient experienced uncommon, 
      delayed, extrahepatic manifestations of disease, and (2) the initial viral 
      hepatitis studies revealed undetectable anti-HAV IgM levels despite having 
      experienced symptoms of illness for several days. This case suggests that repeat 
      viral hepatitis testing may be warranted in patients who continue to experience 
      manifestations of the infection after initially testing negative. It also 
      emphasizes the importance of recognizing potential atypical manifestations of 
      acute hepatitis A infection.
CI  - Copyright (c) 2022, Figg et al.
FAU - Figg, Wesley D
AU  - Figg WD
AD  - Department of Medicine, Baylor College of Medicine, Houston, USA.
FAU - Crawford, David L
AU  - Crawford DL
AD  - Department of Medicine, Baylor College of Medicine, Houston, USA.
FAU - Taylor, Tristen N
AU  - Taylor TN
AD  - Department of Medicine, Baylor College of Medicine, Houston, USA.
FAU - Al Mohajer, Mayar
AU  - Al Mohajer M
AD  - Department of Medicine, Baylor College of Medicine, Houston, USA.
LA  - eng
PT  - Case Reports
DEP - 20220915
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9572876
OTO - NOTNLM
OT  - atypical presentation
OT  - delayed diagnosis
OT  - extrahepatic manifestation
OT  - rare entity
OT  - viral hepatitis a
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/10/20 06:00
MHDA- 2022/10/20 06:01
PMCR- 2022/09/15
CRDT- 2022/10/19 01:48
PHST- 2022/09/15 00:00 [accepted]
PHST- 2022/10/19 01:48 [entrez]
PHST- 2022/10/20 06:00 [pubmed]
PHST- 2022/10/20 06:01 [medline]
PHST- 2022/09/15 00:00 [pmc-release]
AID - 10.7759/cureus.29194 [doi]
PST - epublish
SO  - Cureus. 2022 Sep 15;14(9):e29194. doi: 10.7759/cureus.29194. eCollection 2022 
      Sep.