Arthritis and Rash

Although arthralgias and rash are known to be associated with viral hepatitis,¹they have not received sufficient emphasis as the sole major presenting symptoms of this illness. This report describes 14 cases of hepatitis in which arthralgias or rash were the dominant early manifestations. Eight of the patients remained anicteric throughout their entire illness, while the other six developed jaundice belatedly 2 to 18 weeks after the onset of these symptoms. Methods The diagnosis of viral hepatitis was based on the findings of increased serum glutamic oxaloacetic transaminase (SGOT) levels (14 patients), characteristic percutaneous liver biopsy specimens (four patients), and transiently positive hepatitisassociated antigen (HAA) (ten patients). Serum hemolytic complement and three complement components were measured according to previously published methods²in seven of these patients. Ten of the 14 patients with this syndrome were men. Their ages ranged from 18 to 55 years with the majority being