Title: Rare Presentation of HAV Related Acute Viral Hepatitis
Abstract: Background and Aim: Acute HAV hepatitis is one of the most common causes of acute viral hepatitis around the world. Common Clinical manifestations include anorexia, jaundice, nausea and fever. Uncommon manifestations include relapsing hepatitis, prolonged cholestasis, and ALF. Rare extrahepatic manifestations consist of AKI, haemolytic anaemia, pleural or pericardial effusion, acute reactive arthritis, acute pancreatitis, acalculous cholecystitis, mononeuritis, and Guillain-Barre syndrome. Here we report a case of HAV related Acute viral hepatitis who developed hepatitis complicated by AKI requiring dialysis and acute pancreatitis. Case Report: A 32-year-old, young male patient presented with complaints of fever, jaundice and oliguria. Upon evaluation he had grossly deranged LFT (Total bilirubin 8.15 mg/dl with direct bilirubin 6.82, SGOT 1085 and SGPT 3265) and deranged KFT (urea 81/ creatinine 8.1 with INR of 1.5). His viral markers were positive for HAV and negative for Hepatitis B, C, E. HIV was non-reactive. Other infective (scrub typhus, leptospira, dengue, brucella and malaria) serology was also negative. Ultrasound was suggestive of altered echotexture of liver with enlargement (18.1 cm). CT abdomen showed hepatic steatosis with mild ascites and minimal right pleural effusion. Lactate and blood gases were normal. He was initiated on hemodialysis for acute kidney injury. After initial improvement during hospital stay, he complained of epigastric pain. Amylase and lipase were done to rule out acute pancreatitis which were found to be raised (910 and 3875 respectively). Further MRCP was done which showed changes suggestive of acute pancreatitis. Conclusion: This is a rare case of HAV infection complicated by AKI requiring hemodialysis multiple times and Pancreatitis. Awareness of such a presentation can facilitate the timely diagnosis of atypical but severe manifestations of HAV infection.