A Rare Complication of Hepatitis A in Child with Pleural Effusion: A Case Report from Nepal

Introduction: Hepatitis A is an inflammation of the liver caused by hepatitis A virus (HAV). HAV is usually transmitted via the fecal-oral route (person-to-person contact or consumption of contaminated food or water). HAV is common in developing countries. HAV was diagnosed on the basis of laboratory investigations with a typical clinical presentation. HAV infection in children is usually a minor and self-limiting infection that requires no specific therapy unless acute liver failure or other complications are present. Extrahepatic manifestations of HAV including pleural effusion, acute myocarditis, and renal dysfunction, are rare. The incidence of HAV has declined substantially since the implementation of vaccinations.

Case Presentation: A 5-years old boy, previously well, presented with a cough for 10 days, abdominal pain, and fever for the on and off types.

Case Discussion: After obtaining medical history and physical examination, the child was hemodynamically stable, with mild hepatomegaly and bilateral decreased breath sounds. Ultrasonography revealed moderate bilateral pleural effusion. Based on the investigation and clinical findings, a diagnosis was made, and supportive management was performed. Liver enzyme levels were corrected within three weeks and the pleural effusion disappeared after four weeks.

Conclusion: Pleural effusion is a rare extrahepatic complication of acute hepatitis A that spontaneously resolves. This study is important because it reduces unnecessary invasive procedures such as pleural tapping and patient transfer to a tertiary center for further management. Therefore, the management of pleural effusion in children with jaundice should be considered in the differential diagnosis of Hepatitis A.

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