Hadgu Fikaden Berhe, Alemu Henok Temtime
Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
Pediatric Health Med Ther. 2020 Jun 16;11:189-192. doi: 10.2147/PHMT.S251393. eCollection 2020.
Hepatitis A infection is common in children and often presents with mild hepatic disease. The clinical manifestations of hepatitis A virus are usually related to liver damage but sometimes extrahepatic manifestations may occur.
We present a case of four-year- and eight-month-old male child with anicteric hepatitis A infection associated with a pleural effusion. The patient presented with abdominal pain, low-grade fever, loss of appetite, and vomiting of ten days duration. On examination, there was dullness and decreased air entry on the lower third of the lung field bilaterally and hepatomegaly of 6 cm below the costal margin. Ultrasonography revealed mild ascites, hepatosplenomegaly, and small bilateral pleural effusion. Immunoglobulin M anti-hepatitis A virus serology was positive. He was managed with supportive treatment and fully recovered after a month of follow-up. This case is reported to emphasize that hepatitis A infection should be considered in the differential diagnosis of pleural effusion in a patient with acute hepatitis even in the absence of jaundice. This is the first case of anicteric hepatitis A infection complicated with pleural effusion in children.
This report suggests that pleural effusion can be associated with anicteric hepatitis A infection and should be included in the differential diagnosis of pleural effusion.
甲型肝炎感染在儿童中很常见，通常表现为轻度肝病。甲型肝炎病毒的临床表现通常与肝损伤有关，但有时也可能出现肝外表现。
我们报告一例4岁8个月大的男童，患无黄疸型甲型肝炎感染并伴有胸腔积液。该患者出现腹痛、低热、食欲不振和呕吐，持续10天。检查发现双侧肺野下三分之一处叩诊浊音，呼吸音减弱，肋缘下肝脏肿大6厘米。超声检查显示轻度腹水、肝脾肿大和双侧少量胸腔积液。抗甲型肝炎病毒免疫球蛋白M血清学检查呈阳性。给予支持治疗，随访1个月后完全康复。报告该病例是为了强调，即使在无黄疸的情况下，急性肝炎患者胸腔积液的鉴别诊断中也应考虑甲型肝炎感染。这是首例儿童无黄疸型甲型肝炎感染并发胸腔积液的病例。
本报告提示胸腔积液可能与无黄疸型甲型肝炎感染有关，应纳入胸腔积液的鉴别诊断。
