Coinfection of hepatitis A virus genotype IA and IIIA complicated with autoimmune hemolytic anemia, prolonged cholestasis, and false-positive immunoglobulin M anti-hepatitis E virus: a case report.
A 37-year-old male presented with fever and jaundice was diagnosed as hepatitis A complicated with progressive cholestasis and severe autoimmune hemolytic anemia. He was treated with high-dose prednisolone (1.5 mg/kg), and eventually recovered. His initial serum contained genotype IA hepatitis A virus (HAV), which was subsequently replaced by genotype IIIA HAV. Moreover, at the time of development of hemolytic anemia, he became positive for immunoglobulin M (IgM) anti-hepatitis E virus (HEV). We detected HAV antigens in the liver biopsy specimen, while we detected neither HEV antigen in the liver nor HEV RNA in his serum. This is the first report of hepatitis A coinfected with two different genotypes manifesting with autoimmune hemolytic anemia, prolonged cholestasis, and false-positive IgM anti-HEV.
Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea.
Hee Sup
HS
Kim
Sook Hyang
SH
Jeong
Je Hyuck
JH
Jang
Hyung Joon
HJ
Myung
Jin Wook
JW
Kim
Soo Mee
SM
Bang
Sang Hoon
SH
Song
Haeryoung
H
Kim
Hae Sun
HS
Yun
D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002779:Cholestasis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D060085:Coinfection / Q000175:diagnosis*; D005838:Genotype; D006506:Hepatitis A / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D016751:Hepatitis E / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood
D000893:Anti-Inflammatory Agents; D007075:Immunoglobulin M; D012367:RNA, Viral; D011239:Prednisolone