Pleural Effusion- An Unusual Cause

Vinoth, Ponnurangam Nagarajan; Palaniyandi, Anitha; Muthamilselvan, Sathyamoorthi; Sasidharan, Rajendraprasath; Shuba, Sankaranarayan; Rajakumar, Padur Sivaraman; Scott, Julius Xavier

doi:10.21767/amj.2012.1024

Cited by 3 publications

(7 citation statements)

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“…Rarely, hepatitis A can progress to acute liver failure. Extrahepatic manifestations are infrequently reported in HAV acute hepatitis (6.4–8%) and may include: urticarial and maculopapular rash, acute kidney injury, autoimmune hemolytic anemia, aplastic anemia, acute pancreatitis, mononeuritis, reactive arthritis, Guillain–Barre syndrome and pleural or pericardial effusion, ascites, glomerulonephritis, polyarteritis nodosa, cryoglobulinemia, and thrombocytopenia [ 2 , 3 , 8 ]. …”

Section: Discussionmentioning

confidence: 99%

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

et al. 2022

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Introduction Hepatitis A virus infections are mostly asymptomatic or mildly symptomatic, and generally this disease has a benign course and resolves spontaneously. However, intrahepatic and rarer extrahepatic manifestations can complicate typical cases of acute hepatitis. Pleural effusion is an extremely rare extrahepatic entity with 20 cases reported in literature. Case presentation We report herein a recent case of both pleural effusion and ascites accompanying hepatitis A infection in a 5-year-old middle eastern child, diagnosed using serological testing and imaging studies, who was treated with supportive management with full resolution after 2 weeks. In addition, we review available literature regarding hepatitis A virus associated with pleural effusion using PubMed and summarize all reported cases in a comprehensive table. Results Literature contains 20 reported cases of serology-confirmed hepatitis A virus presenting with pleural effusion, most in the pediatric population with average age at presentation of 9 years 8 months. The majority of reported patients had right-sided pleural effusion (50%) or bilateral effusion (45%), while only 5% presented with pleural effusion on the left side. Hepatomegaly and ascites occurred concurrently in 80% and 70% respectively. Supportive treatment without invasive procedures (except one chylothorax case) yielded complete recovery in 95% of cases, while only one case progressed to fulminant liver failure followed by death. Conclusion Acute hepatitis A virus rarely presents with pleural effusion, usually following a benign course with spontaneous resolution in most patients. Pleural effusion does not change the prognosis or require any invasive treatment. Thus, further invasive procedures are not recommended and would only complicate this self-resolving benign condition.

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Section: Discussionmentioning

confidence: 99%

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

et al. 2022

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“…Probable mechanisms for pleural effusion are transport of fluid from diaphragmatic lymphatics, leakage from a diaphragmatic defect,[ 12 13 18 ] or immune complex deposition. [ 7 12 15 ] For acalculous cholecystitis mechanisms suggested include hypoalbuminemia, extension of hepatic inflammation, or direct viral invasion. [ 19 ] For ascites, similarly, the possible mechanisms are obstruction of veins or lymphatics and hypoalbuminemia.…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 ] For ascites, similarly, the possible mechanisms are obstruction of veins or lymphatics and hypoalbuminemia. [ 7 12 15 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 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,[ 8 9 10 11 12 13 14 15 16 17 ] 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.…”

Section: Introductionmentioning

confidence: 99%

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

Dalai

Malhotra

Gupta

et al. 2018

J Family Med Prim Care

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Hepatitis A is common among children of developing nations. Young children with Hepatitis A infection usually have a mild form of the disease. Serious manifestations like pleural effusion and acalculous cholecystitis are very rare in Hepatitis A infection in young children. There have been some reports of these manifestations of childhood Hepatitis A occurring in isolation but for these to co-exist, is extremely rare. In this article a young child with Hepatitis A infection who had all these three manifestations of pleural effusion, acalculous cholecystitis and ascites together, is reported.

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“…Pleural effusion is a rare complication of hepatitis A that typically occurs in children during the early stages of the disease [3,4]. Ascites is also a rare extrahepatic manifestation, tends to be commonly observed in the later stages of the illness [5].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report

Breim,

Roumi Jamal,

Kanaa

et al. 2024

J Med Case Reports

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Background Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. Case presentation An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. Conclusion Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

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Pleural Effusion- An Unusual Cause

Cited by 3 publications

References 0 publications

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

Acute benign pleural effusion, a rare presentation of hepatitis A virus: a case report and review of the literature

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

Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report

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