Rare presentation of hepatitis A with ascites, pleural effusion and acalculous cholecystitis

Hepatitis A is an important health problem in developing and under-developed countries, including India. Mostly it has a self-limiting course. Extra-hepatic manifestations in form of ascites, pleural effusion and acute acalculous cholecystitis occurring in same patient are not commonly reported. We report a recent case of 8-year-old boy with ascites, right sided pleural effusion and acalculous cholecystitis. Child presented to us with jaundice, pain abdomen and difficulty in breathing. His serology was positive for hepatitis A. He was successfully managed with conservative treatment. No antibiotics were started and no invasive procedures were carried out. Ascites, pleural effusion and acalculous cholecystitis, are rare presentation of hepatitis A that have self-limiting course and don’t affect severity of disease. Physicians should be aware of this rare presentation, so that invasive procedures, unnecessary investigations and undue anxiety of treating doctors and parents could be avoided.