Hepatitis A, cardiomyopathy, aplastic anemia, and acute liver failure: A devastating scenario

Transpl Infect Dis. 2018 Apr;20(2):e12842. doi: 10.1111/tid.12842. Epub 2018 Mar 13.

Abstract

Hepatitis A virus (HAV) causes an acute infection and is usually asymptomatic in children. When clinical manifestations appear, these include choluria, jaundice, and abdominal pain. Although infrequent, extra-hepatic manifestations related to HAV have been described, affecting the heart, bone marrow, blood vessels, and other tissues.A 10-year-old boy from a rural area presented with a 15-day history of malaise, fever, and jaundice; laboratory examinations were compatible with HAV infection. The patient turned encephalopathic and was remitted to our center, where laboratory examinations showed a medullary aplasia and fulminant hepatitis requiring a liver transplant that was performed 72 hours after admission. At 24 hours post transplant, the patient developed a cardiomyopathy secondary to HAV, and intravenous immunoglobulin was administered. The patient is still alive and attending his medical check-ups.Although rare, extra-hepatic manifestations of HAV infection have been described in 14% of cases. The groups of patients affected are usually aged and present with high bilirubin levels. Acquired aplastic anemia and myocarditis caused by HAV are uncommon, and its pathophysiology has not yet been elucidated.HAV infection is usually asymptomatic in children, although extra-hepatic manifestations can appear requiring early detection and management.

Keywords: acute liver failure; cardiomyopathy; hepatitis A virus; liver transplantation; medullary aplasia; pediatric.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Aplastic / complications*
  • Cardiomyopathies / etiology*
  • Cardiomyopathies / therapy
  • Child
  • Hepatitis A / complications*
  • Hepatitis A / therapy
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Liver Failure, Acute / complications*
  • Liver Transplantation
  • Male

Substances

  • Immunoglobulins, Intravenous