# Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report

## TL;DR

A child with hepatitis A virus infection developed rare complications including pleural effusion, acalculous cholecystitis, and ascites, highlighting the need for awareness among pediatricians.

## Contribution

This case report documents the third known instance of a child with hepatitis A virus presenting with three rare extrahepatic complications simultaneously.

## Key findings

- The child showed clinical improvement after conservative management with vitamin K and fluids.
- The coexistence of pleural effusion, acalculous cholecystitis, and ascites with HAV is extremely rare in children.
- This case emphasizes the importance of recognizing rare HAV complications to avoid unnecessary investigations.

## Abstract

Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites.

An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed.

Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.