P-127 HEPATITIS A WITH ACALCULOUS CHOLECYSTITIS, PLEURAL EFFUSION, PERICARDIAL EFFUSION AND ASCITIS

Introduction

In developing countries, hepatitis A constitutes an important public health problem. It generally presents as a mild, self-limited disease, but occasionally it can present with infrequent clinical findings.

Case Presentation

42-year-old female admitted for 7 days of abdominal pain in the right upper quadrant, general malaise, mild dyspnea and fever. With no known morbid history, she is a bodybuilder with frequent use of BCAAs, Glutamine, and occasional anabolic steroids (Oxalandrone, Boldedone, Methenolone). On physical examination, jaundice of the skin and mucous membranes, edema of the lower limbs and palpable spleen, pain on palpation in the right upper quadrant.

In laboratories Hemoglobin 13.3 g / dL; White blood cells: 5400 cells / mm3; Platelets 316 / mm3; AST 849 U / L; ALT 3152 U / L; Total bilirubin 11.1 mg / gL, GGT 1020 U / L; 491 U / L alkaline phosphatase; INR 1.5; Total proteins 5.6 g / dL; Albumin 2.6 g / dL. Nitrogen, electrolytes, ANA antinuclear antibody, lipase, HIV, HVC, HBsAg were within normal parameters, HAV IgM was positive, the serological analysis for E. Barr, Cytomegalovirus were negative. Chest X-ray showed mild bilateral pleural effusion. Liver Doppler showed inflammatory changes in the liver parenchyma, data of acalculous cholecystitis, moderate ascites and splenomegaly. An echocardiogram was performed that showed slight posterior pericardial effusion with a heart of normal morphology and function. The patient was managed with supportive and nutritional therapy, without progression of clinical symptoms, was discharged on the 8th day of admission and was seen for consultation 1 month later with image and laboratory control, with disappearance of cholecystitis, pleural and pericardial effusion and ascites, and decreased laboratory levels of the liver profile.

Conclusion

This is one of the few documented cases of hepatitis A with these complications, all found in the same patient, they have been described as rare forms of presentation in the course of hepatitis A.