ATYPICAL, CHOLESTATIC FORM OF HEPATITIS A WITH AN EXTRAHEPATIC, CUTANEOUS MANIFESTATION – A CASE REPORT

Hepatitis A sometimes can present through atypical forms and merged extrahepatic manifestations. Most atypical forms include relapsing hepatitis and cholestatic hepatitis. Extrahepatic manifestations of HAV are rare, and include evanescent skin rash and transient arthralgias. A 25-year-old male, previously healthy, developed acute hepatitis. Hepatitis A virus was serologically confirmed. No skin efflorescences were seen at the beginning. Over the course of the illness which extended up to fifteen weeks, bilirubin and aminotransferase levels were continuously highly elevated. Nine weeks after the initial presentation he developed a painless, non-pruritic, purpura-like maculopapular erythematous rash over both lower extremities. Five weeks later, the rash had completely disappeared and the patient’s clinical status much improved. This case demonstrates two unusual and unrelated manifestations: prolonged cholestatic form of hepatitis and cutaneous vasculitis. Possible unusual manifestations of this disease should be a reminder of a brief diagnostic examination, which is usually not done in hepatitis A.