Prolonged Cholestatic as a Typical Manifestation of Hepatitis A Infection: Diagnosis and Management

Nikko Darnindro, C. Rinaldi Lesmana

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Hepatitis A virus (HAV), a positive-strand RNA virus, is stable at moderate temperature and low pH level. These characteristics allow the virus to survive in the environment and be transmitted through fecal-oral route.Twenty-year-old male came with jaundice and itchy skin since one month before admission. He was diagnosed as hepatitis A cholestasis type according to his history taking, physical examination, and laboratory result. Blood test showed elevated total bilirubin 27.4 g/dL, direct bilirubin 21.2 g/dL, indirect bilirubin 6.2 g/dL, alanin aminotransferase (ALT) 95 U/L, aspartate transaminase (AST) 134 U/L, alkaline phosphatase (ALP) 221 U/L, and gamma-glutamyltransferase (gGT) 17 U/L. His ultrasound results showed mild, non-specific hepatomegaly without common bile duct dilatation. The patient got symptomatic therapy with ursodeoxycholic acid (UDCA) 300 mg twice daily for his itchy skin and steroid therapy 0.5-1 mg/kg per day on the tenth day. He did not vomit or feel nausea anymore. After five days of steroid therapy, his total bilirubin level became 10.83 g/dL. He was discharged home with steroid therapy and steroid was tapered off during follow-up in the clinic.Prolonged cholestasis is one of atypical manifestation of hepatitis A which is rarely found. Cholestasis increases morbidity and prolongs hospitalization. Steroid therapy decreased bilirubin level and gave clinicalimprovement to the patient.
Original languageEnglish
JournalThe Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Publication statusPublished - 2013


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