# Prolonged Cholestatic Hepatitis A in an Unvaccinated International Traveler

## TL;DR

A 33-year-old unvaccinated man developed a long-lasting hepatitis A infection after traveling to a region with poor sanitation, highlighting the need for vaccination.

## Contribution

This case highlights the prolonged cholestatic course of hepatitis A in adults and emphasizes the importance of vaccination in travel medicine.

## Key findings

- The patient had prolonged jaundice and diarrhea for over two months after contracting hepatitis A.
- HAV RNA was detected in feces for an extended period, indicating prolonged viral shedding.
- Symptomatic treatment and ursodeoxycholic acid led to clinical resolution after four months.

## Abstract

Hepatitis A is a viral infection that is generally self-limited, although atypical, prolonged forms and fatal outcomes may occur. This case report describes a 33-year-old Brazilian man, previously healthy and unvaccinated, who developed prolonged cholestatic hepatitis A acquired during international travel. He had traveled through areas with precarious sanitation and consumed untreated water in a rural region of Zambia, Africa. Initial symptoms were nonspecific and progressed to jaundice, dark urine, and acholic stools. The diagnosis of acute hepatitis A was confirmed serologically, with markedly elevated transaminases and predominantly direct hyperbilirubinemia. Despite initial clinical improvement, he persisted with jaundice and diarrhea for more than two months, with continued fecal shedding of hepatitis A virus (HAV) RNA. Treatment included symptomatic medications and ursodeoxycholic acid due to cholestasis, with good clinical resolution after four months. This report aims to highlight the prolonged course of hepatitis A in adults, distinct from the typically faster resolution observed in children, and to reinforce the importance of vaccination among the general population and in travel medicine counseling, especially for adults from countries with low endemicity for hepatitis A.