Cholestatic hepatitis A infection during childhood

Abstract

The aim of this study was to evaluate the clinical evolution and prognosis of cholestatic hepatitis A during childhood. A retrospective study of 33 children hospitalized for acute hepatitis A infection between June 1998 and May 2002 were studied. Cholestatic hepatitis was defined by a direct bilirubin higher than 50% of the total bilirubin and serum bilirubin levels greater than 10 mg/dL during at least 4 weeks. Five cases were identified, which represents 15.2% of all hospitalized hepatitis A cases. One of the five cases had a combination of the two variants of acute viral hepatitis A, the relapsing and cholestatic forms. Physical findings include prolonged jaundice, pruritis and hepatomegally. Cholestatic symptomatology was predominant in all cases with bilirubin values ranging from 24 to 45 mg/dL. Prolonged prothrombin times, corrected with vitamin K, were seen in three of these patients. Four patients were treated with ursodeoxycholic acid, one patient with ursodeoxycholic acid plus short-term prednisone therapy. All patients recovered completely without sequelae. Cholestatic hepatitis is an infrequent and benign form of acute hepatitis A in childhood. Knowledge of this unusual manifestation of hepatitis A may help avoid potentially invasive procedures involved in the evaluation of suspected obstructive jaundice.