Hepatitis A virus (HAV) infection in children is typically an acute, self-limited illness associated with general, nonspecific symptoms, such as fever, malaise, anorexia, vomiting, nausea, abdominal pain or discomfort, and diarrhea. During the prodromal period, aminotransferases are typically elevated. Jaundice usually occurs one week after onset of symptoms, along with dark urine and mild hepatomegaly , and lasts for less than two weeks with no complications . Prolonged cholestasis is a rare atypical form of hepatitis A virus (HAV) infection that is characterized by serum bilirubin levels higher than 10 mg/dL for more than 12 weeks. Aplastic anaemia is another very rare complication of hepatitis A. We report one case of cholestasis and aplastic anaemia post fulminate hepatitis A infection in 11 year old Libyan male . Previous study in Libya showed positive IgG antibodies against Hepatitis A virus in all children studied by the age of 7 years. Our patient cholestatic jaundice and liver function tests rapidly responded to steroid treatment followed by rapid tapering. A short course of steroid besides inducing a rapid decline in serum bilirubin levels and relief of pruritus, are known to shorten the duration of prolonged cholestasis. Hepatits Associated Aplastic anaemia is a rare complication of hepatitis A virus. The majority of the reported cases have blood group A, patients with blood group O has also been reported .Our patient was young male with blood group O+ve developed severe aplastic anaemia post fulminant hepatitis A infection.
Our patient denied any history of traditional herbal treatment but on examination of the skin ,we noted several cautery marks. The marrow aplasia is mediated by immunological mediators possibly by gamma interferon or cytokine cascade, immunosuppressive therapy has been shown to have 70% response rate . With bone marrow transplantation, 82% of patients survive beyond 5 years , our patient was on immunosuppressive medication and listed for urgent bone marrow transplant.
Key words: Hepatitis A, Cholestasis, Aplastic anaemia