title: Isolated digital gangrene complicating hepatitis a infection in a child.
abstract: Hepatitis A virus is rarely associated with extrahepatic complications. A child presented with a history suggesting Raynaud's phenomenon and severe digital gangrene, as a complication of hepatitis A infection. Coagulation study results (protein C, protein S, antithrombin III, and activated protein C resistance) were all normal except for anticardiolipin antibodies, which were present on initial presentation and resolved later. Antinuclear antibodies, rheumatoid factor, lupus anticoagulant, antineutrophilic cytoplasmic antibodies, and Venereal Disease Research Laboratory test were all negative. Cryoglobulins were not detected. C3 and C4 levels were normal. Blood urea nitrogen and creatinine levels were normal as well. The patient was treated with aspirin and diclofenac, and improved slowly with complete resolution of gangrene and symptoms after 3 months. She remains asymptomatic 4 years later. Transient antiphospholipid syndrome or isolated Raynaud's phenomenon may be added to the list of extrahepatic complications of hepatitis A.
authors.affiliation: Department of Pediatrics, Makassed General Hospital, Beirut.
authors.forename: Samar
authors.initials: S
authors.lastname: Muwakkit
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Ajam
authors.forename: Thurayya
authors.initials: T
authors.lastname: Arayssi
authors.forename: Dana
authors.initials: D
authors.lastname: Hasbini
authors.forename: Abdul Fattah
authors.initials: AF
authors.lastname: Masri
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mikati