Korean J Hepatol.
2011 Dec;17(4):323-327. 10.3350/kjhep.2011.17.4.323.
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
- Affiliations
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- 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. jsh@snubh.org
- 2Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
- 3Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
- 4Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, Korea National Institute of Health, Seoul, Korea.
- KMID: 1792612
- DOI: http://doi.org/10.3350/kjhep.2011.17.4.323
Abstract
- 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.
Keyword
MeSH Terms
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Adult
Anemia, Hemolytic, Autoimmune/*diagnosis/drug therapy/etiology
Anti-Inflammatory Agents/therapeutic use
Cholestasis/*diagnosis/drug therapy/pathology
Coinfection/*diagnosis
Genotype
Hepatitis A/complications/*diagnosis/genetics
Hepatitis E/complications/*diagnosis/genetics
Humans
Immunoglobulin M/blood
Liver/pathology/virology
Male
Prednisolone/therapeutic use
RNA, Viral/blood
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