P273 Atypical outcome in a child with hepatitis a infection

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Although hepatitis A can be controlled through vaccination, in Romania it still represents a public health problem. In childhood, hepatitis A virus infection is symptomatic or moderately symptomatic. Clinical manifestations can vary from anicteric limited infection to fulminant hepatic failure. Associated severe manifestations of hepatitis A were reported in less than 1% of cases. Several studies have shown that the incidence of complications of hepatitis A is high in patients with chronic liver damage.

Case report

The authors present a case of viral hepatitis type A with atypical outcome and prognosis. It is the case of a 11 years old girl, with cholestasis syndrome after prolonged infection with hepatitis A, transferred to the Paediatric Clinic from Infectious Diseases Hospital. She had a history of liver disease and no other significant diseases. Clinical examination revealed intense sclero-tegumental jaundice, trophic skin lesions, hepatomegaly, splenomegaly, no acholic stools or dark urine, no signs of meningeal irritation. Laboratory examinations revealed the presence of severe cholestasis syndrome and moderate hepatic cytolysis. Ultrasound and CT showed mild hepatomegaly.

Case report

Dosage of specific antibodies: antinuclear atb. -c ANA, anti-smooth muscle fibre atb. – ASMA, antimitochondrial atb.- AMA and serum gamma globulins were within normal limits, thus excluding the diagnosis of autoimmune hepatitis and primary biliary cirrhosis. Were excluded hepatitis B and C infections and reinfection with hepatitis A virus. The described clinical features were characteristic for a infection with hepatitis A virus complicated with prolonged cholestatic syndrome. It was established the treatment with ursodeoxycholic acid, with favourably outcome.


In general, the evolution in viral hepatitis type A is favourable, but in a small percentage of cases, the child may manifest prolonged cholestatic jaundice, requiring special follow-up.

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