title: [Hepatitis A - combined prolonged biphasic and cholestatic course of disease].
abstract: METHODS
  One month after a first manifestation of a hepatitis A infection and transaminases had become normal, a 44-year-old woman again became jaundiced with accompanied by weakness, nausea and nocturnal sweating.
  
  
  METHODS
  Laboratory tests again showed features of hepatitis with decreased synthetic liver function and hyperbilirubinemia, changes which persisted for 12 weeks. Serological and virological studies revealed a positive test for anti-hepatitis A virus (HAV) IgM and HAV-RNA was detected in the stool.
  
  
  METHODS
  These tests demonstrated two rare features of hepatitis A, namely a prolonged biphasic course combined with cholestasis form. In addition a hemolytic anaemia developed.
  
  
  CONCLUSIONS
  The severity of a relapse of hepatitis A varies: in this case it was more severe than the initial manifestation. The reasons for the different courses of hepatitis A infection remain unclear.
authors.affiliation: Medizinische Klinik und Poliklinik II, Klinikum Großhadern, Ludwig-Maximilians-Universität München. Laura.Schmidt@med.uni-muenchen.de
authors.forename: L
authors.initials: L
authors.lastname: Schmidt
authors.forename: R
authors.initials: R
authors.lastname: Zachoval
authors.forename: H
authors.initials: H
authors.lastname: Diepolder
authors.forename: F T
authors.initials: FT
authors.lastname: Kolligs
mesh_terms: D000208:Acute Disease; D000328:Adult; D000818:Animals; D049872:Bivalvia / Q000821:virology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005516:Food Microbiology; D006506:Hepatitis A / Q000175:diagnosis* / Q000276:immunology / Q000635:transmission; D035922:Hepatitis A Antibodies / Q000097:blood; D030041:Hepatitis A virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D041781:Jaundice, Obstructive / Q000175:diagnosis* / Q000276:immunology*; D008111:Liver Function Tests; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence
chemical_list: D035922:Hepatitis A Antibodies; D007075:Immunoglobulin M; D012367:RNA, Viral