Pleural Effusion Associated with Anicteric Hepatitis A Virus Infection – Unusual Manifestation of a Common Disease: A Case Report

BACKGROUND: Hepatitis A infection is common in children and often presents with mild hepatic disease. The clinical manifestations of hepatitis A virus are usually related to liver damage but sometimes extrahepatic manifestations may occur. CASE PRESENTATION: We present a case of four-year- and eight-month-old male child with anicteric hepatitis A infection associated with a pleural effusion. The patient presented with abdominal pain, low-grade fever, loss of appetite, and vomiting of ten days duration. On examination, there was dullness and decreased air entry on the lower third of the lung field bilaterally and hepatomegaly of 6 cm below the costal margin. Ultrasonography revealed mild ascites, hepatosplenomegaly, and small bilateral pleural effusion. Immunoglobulin M anti-hepatitis A virus serology was positive. He was managed with supportive treatment and fully recovered after a month of follow-up. This case is reported to emphasize that hepatitis A infection should be considered in the differential diagnosis of pleural effusion in a patient with acute hepatitis even in the absence of jaundice. This is the first case of anicteric hepatitis A infection complicated with pleural effusion in children. CONCLUSION: This report suggests that pleural effusion can be associated with anicteric hepatitis A infection and should be included in the differential diagnosis of pleural effusion.