Atypical Hepatitis A Infection in Children: A Case Series and Review of Literature

Acute Hepatitis A viral infection (HAVI) in children usually presents with a classical clinical prodrome followed by jaundice. In contrast to this typical presentation, a myriad of atypical manifestations are reported. We report a case series of 6 children with acute HAVI with varied atypical manifestations. Case 1: 14-year-old-boy presented with fever and jaundice for 5 days. Investigations revealed thrombocytopenia with positive IgM-HAV. The platelet counts improved over 1week without any intervention. Case 2: 2-month-old baby presented with a 7-day history of fever and loose stools. Her mother was affected with hepatitis A infection. The baby was tested positive for IgM-Hepatitis-A. She improved in 1 week. Case 3: 11-year-old-boy presented with abdominal pain and jaundice of 20 days duration. In view of icterus, he was investigated for hepatotropic virus and he had HAVI co-infection with salmonella. This child improved with IV ceftriaxone. Case 4: 12-year-old boy presented with fever and jaundice for 3 days who tested positive for IgM-Hepatitis-A. Ultrasound showed ascites which improved in 2 weeks with supportive treatment. Case 5: 11-year-old-boy presented with fever, icterus, hepatomegaly, ascites and pleural effusion for one-month. Although the child was positive for Anti-HAV-IgM titers, investigations revealed coinfection with scrub-typhus. The child improved with Doxycycline. Case 6: 6-year-old boy presented with fever, jaundice and nausea for 7 days. IgM Anti-HAV titers were positive with right sided pleural effusion, which resolved in 2 weeks. Conclusion: Apart from typical findings in HAVI, it is important to look for atypical features and course for better management.