LC, Acute : PE-121 ; A case of acute biphasic hepatitis A = LC, Acute : PE-121 ; A case of acute biphasic hepatitis A

다국어 초록 (Multilingual Abstract)

Background: The hepatitis A virus usually causes an acute self-limited illness which is typically short lived, and a full recovery is expected within a few weeks, after which the patient has life long immunity to the virus. But in a few case, HAV causes a biphasic or relapsing illness, with a second bout of jaundice and cholestasis 6 to 12 weeks after the primary infection. Case: A 34-year old women was admitted, with the complaints of fatigue, whole body itching sense, jaundice and nausea which beginning 13 days prior to admission. In prior admission, AST/ALT was 555/2,249 IU/L and HAV Ab IgM was positive. The patient diagnosed acute hepatitis A. After conservative therapy for 8 days, symptoms were improved and AST/ALT were 68/274, total bilirubin checked 5.92 and discharged. But after discharge, she readmitted again due to re-elevation of bilirubin. She never drunk nor smoking, and had no medical history. She complaint whole body ithcing sense, fatigue, nausea. Vital sign was BP 100/60 mmHg, HR 66/min, RR 20/min, and BT 36.5℃. Yellow discoloration of the skin and sclera was noted. Laboratory findings shows that white blood cell, hemoglobin, and platelet counts were 5.280/mm3, 11.4 g/dL, and 253,000/mm3, respectively. Prothrombin time was 8.8 sec. The total protein/albumin were 6.6 g/dL/3.7 g/dL, AST/ ALT 82/76 IU/L, and total bilirubin was 9.78 mg/dL, ALP/ r-GTP were 122 U/L/18 U/L. HBsAg/anti-HBs were negative/ positive, anti-HCV was negative. ANA, anti-mitochondria antibody, anti-smooth muscle antibody, ASMA were all negative. Liver biopsy demonstrated acute cholestatic hepatitis. After conservative therapy, total bilirubin was decreased from 7 days after readmission, and whole body itching sense, fatigue, nausea, and liver function test were improved. Conclusions: We present our patient as a rare clinical example of ``biphasic hepatitis A``. In this case, patient diagnosed hepatitis A by typical symptom, liver function test, serologic test. Symptom was improved after conservative therapy 1 week. But 2 weeks later, liver function test and symptom was aggravated. Further study is needed to clarify the true algorism of the relapsing hepatitis A.