title: A rare presentation of hepatitis a infection with extrahepatic manifestations.
abstract: Hepatitis A has a variety of associated extrahepatic manifestations that clinicians should be aware of for early diagnosis and treatment. We report a unique case of hepatitis A presenting with multiple extrahepatic manifestations not previously described in a single patient. A 34-year-old male presented with sudden onset of left sided facial pain, swelling, and skin rash, with diffuse body pains and muscle weakness, and was found to be positive for hepatitis A immunoglobulin M (IgM). He was initially started on antibiotics for concerns of bacterial parotitis but did not show any improvement. A punch biopsy of his mandibular rash and swelling was done which showed lymphohistiocytic infiltration with a few eosinophils. A trial of prednisone resulted in improvement of his symptoms. Clinicians should be aware to look for hepatitis A infection in a patient with atypical clinical picture causing a widespread systemic inflammatory response. Treatment with prednisone may result in resolution.
authors.affiliation: Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA.
authors.forename: Geetika
authors.initials: G
authors.lastname: Bhatt
authors.affiliation: Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA.
authors.forename: Varrinder S
authors.initials: VS
authors.lastname: Sandhu
authors.affiliation: Medicine and Pediatrics, Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA.
authors.forename: Charlene K
authors.initials: CK
authors.lastname: Mitchell