Case history
Case history
A 34-year-old man presents 2 weeks after returning from a month-long trip to India. He denies attending pre-travel vaccination clinic and did not take prophylaxis of any sort while in India. He reports a 6-day history of malaise, anorexia, abdominal pain, nausea with emesis, and dark urine. He consumed salad at a road-side vendor 3 weeks before onset of symptoms. On examination there is icterus. His alanine transaminase (ALT) is 5660 units/L, and total bilirubin 153.9 micromols/L (9 mg/dL). Serum IgM anti-hepatitis A virus antibodies are detected.
Other presentations
Hepatitis A can present atypically with severe thrombocytopenia.[3] Other atypical extrahepatic manifestations of hepatitis A include vasculitis, arthritis, optic neuritis, transverse myelitis, aplastic anaemia, and red cell aplasia.[4]
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