Background: Hepatitis A virus (HAV) infection is self-limiting with spontaneous remission in 90% of cases. Atypical manifestations occur in a subset of patients. Aims and Objectives: The study was designed to evaluate the clinical presentation, biochemical profile, concomitant drug-induced liver injury (DILI), response to steroids, and severe outcomes in patients with acute viral hepatitis A. Materials and Methods: This prospective observational study included 105 HAV patients aged 8–45 years at a tertiary care hospital in North India. Clinical, biochemical, serological, and autoimmune parameters were assessed. Patients were monitored for atypical manifestations such as the presence of prolonged cholestasis (>4 weeks), autoimmune features, DILI, and extrahepatic involvement. Steroid response and severe outcomes were analyzed. Statistical analysis was performed using the Statistical Package for the Social Sciences. Results: In 105 patients, the mean age was 26.5 years. 18% fell in the pediatric age group (20 mg/dL. Transaminases ranged from 300 to 4000 U/L (mean, 2150 U/L). Cholestatic injury occurred in 80% of patients. DILI in 5% and autoimmune features in 5.7%. Sixty patients received steroids, all showing significant clinical and biochemical improvement (P≤0.05). No extrahepatic manifestations were noted. Acute liver failure (ALF) was observed in 2.9%. Out of which, one patient recovered after liver transplantation. One recovered with plasma exchange, and one died. Conclusion: HAV infection spectrum ranges from cholestatic injury to severe forms such as acute liver failure (ALF). Early recognition of atypical features and selective steroid use may improve outcomes.
Wani et al. (Mon,) studied this question.