Relapsing hepatitis A. Review of 14 cases and literature survey.
We have reviewed our experience with 14 cases of relapsing hepatitis A (RH-A), as well as 68 cases reported in the literature. Relapse occurs in 3 to 20% of patients with acute hepatitis A, and rarely takes the form of a polyphasic disease (multiple relapses). After a stage of typical hepatitis A, remission phase ensues, with partial or complete resolution of clinical and biochemical manifestations. Relapse usually occurs after a short period (usually less than 3 weeks). Relapse is usually clinically milder than the first phase, with variable liver function abnormalities and a tendency toward more marked cholestatic features. Not uncommonly, immune manifestations occur during this phase, including purpura, nephritis, and arthralgia, with common laboratory findings of rheumatoid factor as well as false-positive reaction to HCV-EIA tests. The clinical course in relapsing hepatitis A is almost always benign, and uneventful recovery is the rule with few exceptions. Steroid treatment, first reported in the present series, resulted in marked clinical improvement. Preliminary results suggest that R-HA is associated with a continuing viremia as well as shedding of virus in stools during the relapse phase. The pathogenesis of R-HA probably involves an interaction between persistent viral infection and immune mechanisms responding to the continuing antigenic stimulation.
Glikson
M
M
Department of Medicine A, Hadassah University Hospital, Jerusalem, Israel.
Galun
E
E
Oren
R
R
Tur-Kaspa
R
R
Shouval
D
D
D000328:Adult; D004198:Disease Susceptibility; D005260:Female; D006506:Hepatitis A / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006507:Hepatovirus / Q000235:genetics; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012698:Serologic Tests
D012367:RNA, Viral; D011241:Prednisone