Korean J Gastroenterol.  2012 Sep;60(3):177-181. 10.4166/kjg.2012.60.3.177.

A Case of Severe Acute Hepatitis A Complicated with Pure Red Cell Aplasia

• Lim PS
• Kim IH
• Kim SH
• Lee SO
• Kim SW

• KMID: 1389727
• DOI: http://doi.org/10.4166/kjg.2012.60.3.177

Abstract

Hepatitis A is typically a self-limited acute illness that does not progress to chronic hepatitis. In rare cases, acute hepatitis A can be associated with serious complications (such as fulminant hepatitis or acute kidney injury) and may result in death or liver transplantation. Pure red cell aplasia (PRCA) is a rare hematologic disorder characterized by anemia, reticulocytopenia in the blood, and isolated erythroblastopenia with normal granulopoiesis and megakaryopoiesis in the bone marrow. PRCA is a rare hematopoietic complication of acute viral hepatitis, and few cases associated with hepatitis A virus infection have been reported. Recently, we experienced a case of severe hepatitis A complicated by fulminant hepatitis and acute kidney injury followed by PRCA which showed a favorable response to oral corticosteroids.

Keyword

Hepatitis A; Severe hepatitis; Pure red-cell aplasia

MeSH Terms

Acute Disease
Acute Kidney Injury/etiology
Adult
Anti-Inflammatory Agents/therapeutic use
Bone Marrow/pathology
Female
Hepatitis A/complications/*diagnosis
Humans
Prednisone/therapeutic use
Red-Cell Aplasia, Pure/complications/*diagnosis/drug therapy

Figure

• 

  Fig. 1 Photomicrographs of bone marrow aspirate (A, Wright-Giemsa stain, ×400), and bone marrow biopsy (B, H&E, ×400) showing hypoplasia of erythroid precursors with normal myeloid and megakaryocytic cells.

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  Fig. 2 Changes in serum hemoglobin, total bilirubin, and creatinine levels during the illness. CRRT, continuous renal replacement therapy.

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