Cholestatic acute viral hepatitis A with extrahepatic manifestations and rare neurological complications
Keywords:
acute cholecystitis, central pontine myelinolysis, viral hepatitis.Abstract
Introduction: In patients with acute viral hepatitis A, cholestasis is intrahepatic and extrahepatic manifestations are infrequent.
Objective: To present a patient with acute viral hepatitis A with extrahepatic manifestations, and rare neurological complications.
Clinical case: A 21-year-old male patient with no epidemiological history of interest was admitted with acute abdominal pain in the right hypochondrium, vomiting and obstructive icterus. Initial results of hemochemical and imaging examinations suggested acute cholecystitis. Choledochal lithiasis was suspected in his clinical evolution. The patient presented with non-encephalopathic neurological symptoms, which resulted in pontine central myelinolysis, confirmed by magnetic resonance imaging. Endoscopic retrograde cholangiopancreatography was performed, which excluded an obstructive cause in the bile ducts. With the results of the viral markers for hepatitis A, B and C viruses, acute viral hepatitis type A (with cholestatic presentation) was diagnosed. The patient was treated with ursodeoxycholic acid with a favorable response to treatment and clinical evolution towards convalescence.
Conclusions: Cholestatic acute viral hepatitis A may present with infrequent extrahepatic manifestations, such as acute alithiasic cholecystitis and neurological complications unrelated to liver disorders.
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