Hepatitis A with pleural effusion: a rare association

Abstract

Hepatitis A is the most common cause of viral hepatitis in children. Its association with pleural effusion has rarely been reported. The present communication describes three cases of hepatitis A associated with pleural effusion. All three had complete clinical, biochemical and radiological recovery. In view of spontaneous resolution, diagnostic or therapeutic pleural tap is not warranted.

<p>Pleural Effusion Associated with Anicteric Hepatitis A Virus Infection – Unusual Manifestation of a Common Disease: A Case Report</p>

“…Hepatitis A infection in children may present in apparent, subclinical (there is evidence of liver damage on laboratory examination), symptomatic but without evidence of jaundice or with jaundice. 10 Abdominal pain, fever, nausea, vomiting, fatigue, loss of appetite, abdominal distension and jaundice are common manifestations of hepatitis A virus infection in the symptomatic child. Children below 6 years are at less risk of symptomatic HAV infection and less than10% of them manifesting with jaundice.…”

“…But it is seldom associated with atypical manifestations including anasarca, 5 pleural effusion and ascites 6,7 pleural effusion, ascites, and acalculous cholecystitis 8 and isolated pleural effusion. [9][10][11][12] We report a child with anicteric acute hepatitis A infection with bilateral pleural effusion and ascites, who improved with supportive management.…”

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“…Hepatitis A infection in children may be in apparent (asymptomatic and normal liver enzymes), subclinical (asymptomatic but elevated liver enzymes), anicteric (symptomatic but without jaundice) or icteric [4]. Abrupt onset of fever, abdominal pain, nausea, vomiting, fatigue, loss of appetite, abdominal distension and jaundice are common features of HAV infection in the symptomatic child.…”

“…Extrahepatic manifestations are reported in 6.4-8% of cases; they include arthralgia, cutaneous vasculitis, cryoglobulinemia, hemophagocytic syndrome, acalculouscholecystitis, pancreatitis, aplastic anemia, aseptic meningitis, GullainBarre syndrome, transverse, myelitis, vasculitis, acute tubular necrosis, pericardial effusion, ascites, and pleural effusion [1,2]. Pleural effusion is an extremely rare presentation of HAV infection in children [3] with most of the cases being reported having associated ascites as well [4][5][6][7][8][9][10].…”

A rare case of childhood Hepatitis A infection with pleural effusion, acalculous cholecystitis, and ascites

“…[6] Pleural effusion and acalculous cholecystitis are very uncommon manifestations of childhood hepatitis A infection. [7] There have been a few case reports of isolated pleural effusion,[891011121314151617] and pleural effusion and ascites[15] or anasarca[16] in cases of childhood hepatitis A infection. However, we could find only one case report to the best of our knowledge, of all these three manifestations occurring in a single child.…”