Subscribe to DeepL Pro to translate larger documents.

Visit www.DeepL.com/pro for more information.

Zalloum et al. Journal of Medical Case Reports ( 2022) 16:231

https://doi.org/10.1186/s13256-022-03449-w

CASE REPORT Access

Acute benign pleural effusion, a rare

presentation of hepatitis A virus: a case report
and review of the literature
Jihad Samer Zalloum1* , Tareq Z. Alzughayyar1 , Fawzy M. Abunejma2 , Ibba Mayadma1 , Layan Ziad Tomeh1 ,
Karim Jamal Abulaila1 , Asil Husam Yagmour1 , Khalid Jamal Faris1 , Mohammed A. S. Aramin1 ,
Mo'min Ra'id Mesk1 , Asala Khalil Hasani3 , Balqis Mustafa Shawer3 , Rawand Hisham Titi3 , Ayat A. Z. Aljuba3 ,
Hussam I. A. Alzeerelhouseini1 and Yousef I. M. Zatari4

Abstract
Introduction: Hepatitis A virus infection is mostly asymptomatic or mildly symptomatic, and the disease generally has
a benign course and resolves spontaneously. However, more rare intrahepatic and extrahepatic manifestations can
complicate cases of acute hepatitis. Pleural effusion is a very rare extrahepatic entity with 20 cases reported in the
literature.
Case presentation: Here we report a case of pleural effusion and ascites accompanying hepatitis A infection in a
5-year-old child from the Middle East, diagnosed using serologic tests and imaging studies, who was treated with
supportive management with full resolution after 2 weeks. In addition, we reviewed the available literature
regarding hepatitis A virus associated with pleural effusion using PubMed and summarized all reported cases in a
comprehensive table.
Results: The literature contains 20 reported cases of serologically confirmed hepatitis A virus presenting with pleural
effusions, mostly in the pediatric population with a mean age at presentation of 9 years 8 months. The majority of
reported patients had right-sided pleural effusions (50%) or bilateral effusions (45%), while only 5% presented with
pleural effusions on the left side. Hepatomegaly and ascites occurred simultaneously in 80% and 70%, respectively.
Supportive care without invasive procedures (except one case of chylothorax) resulted in complete recovery in 95% of
cases, while only one case progressed to fulminant liver failure followed by death.
Conclusion: Acute viral hepatitis A rarely presents with pleural effusion, usually following a benign course with
spontaneous resolution in the majority of patients. Pleural effusions do not alter prognosis or require invasive
treatment. Therefore, further invasive procedures are not recommended and will only complicate this benign, self-
limiting condition.
Keywords: Pleural effusion, Ascites, Acute hepatitis, Acute hepatitis A virus, HAV associated with limited pleural
effusion, Unusual manifestations, Conservative management

*Correspondence: Jihad.s.zalloum@gmail.com
1
Faculty of Medicine, Al-Quds University, Main Campus, P.O. Box 89, Abu
Dis, Palestine
A full list of author information is available at the end of the article
Introduction
Hepatitis A virus (HAV) is a positive-stranded
ribonucleic acid (RNA) virus that is stable at moderate
temperatures and low pH, so it can survive for a long
time in the environment and transmission through
feces. It has been known

Subscribe
© Author(s) to DeepL
2022. Open Access This articlePro to under
is licensed translate larger
a Creative Commons documents.
Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to
Visit
the original www.DeepL.com/pro
author(s) and the source, provide a link to the for more
Creative information.
Commons license, and indicate whether any changes were
made. Images or other third-party materials in this article fall under the article's Creative Commons license, unless otherwise noted in
the credit line on the material. If the material does not fall under
in the article's Creative Commons license and your intended use is not permitted by law or exceeds the permitted use, you must
obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication Waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data
provided in this article, unless otherwise noted in the credit line on the data.
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 2
Reports

normal.
Table 1 Laboratory analysis
Laboratory analysis Results

Hb11. 7 g/dl
WBC 6.5 × 103 cells/mm3
PLT 230×10/mm33
HAV Igm Serology + ve HAV IgM
-ve Coombs indirect
PT14. 4 (control 12.3)
PTT25 (26 controls)
INR 1.17
Albumin2. 9 g/dl
GGT101 U/l
ALP410 IU/l
Amoniaserum115
UG/dl
Coombs Test Negative
Hb: Hemoglobin, WBC: White blood cells, PLT: Platelets, PT: Prothrombin
Time, PTT: Partial Thromboplastin Time, INR: International normalized ratio,
GGT: amma-glutamyl transferase, ALP: alkaline phosphatase, BUN: Blood
urea nitrogen
Urinalysis is also normal

Hepatitis A is easily spread among children, especially in

developing countries due to poor hygiene and lack of
sanitation [1]. Although hepatitis A is usually
asymptomatic or presents with mild symptoms in
children, extrahepatic symptoms and, in particular,
pleural effusion are rare [2, 3]. The first case of pleural
effusion caused by hepatitis A as the underlying
infection was described as early as 1971 by Gross and
Gerding [4], but this association is rarely reported in the
medical literature, with no more than 20 cases [5]. Here
we provide a comprehensive literature review of 20
published cases and also report a new case, to clarify this
rare entity.

Case presentation
A previously healthy 5-year-old Middle Eastern boy
with no medical history presented to the emergency
department with jaundice and scleral jaundice, in
addition to dark urine, abdominal pain and bloating,
and slight shortness of breath that started 4 days earlier
after a history of contact with a person who had
symptoms of acute hepatitis A.
He has no history of traveling, blood transfusions,
bleeding, or previous medical, drug, or surgical
treatments.
On arrival, during physical examination, the patient
had a high fever (39°C), abdominal distension,
hepatomegaly with normal spleen size, decreased right-
sided unilateral basal breathing sounds and dull breath
sounds, as well as tachycardia and tachypnea. The rest of
the examination was normal, including mental status
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 3
Table
Reports2 Tracking of liver biochemical markers during the stay in the
hospital
Tracking liver biochemical First day Day 2 Day 3
markers during stay
at the hospital
AST (U/l) 470 396 300
ALT (U/l) 883 654 578
Total bilirubin (mg/dl) 8.9 4.1 4.1
Direct bilirubin (mg/dl) 6.6 2.7 3
AST Aspartate aminotransferase, ALT: alanine
aminotransferase On day 5 post-discharge, follow-up LFTs
normalized

The patient was admitted, and laboratory

examinations were performed (Tables 1, 2). HAV
serology test results were positive. Chest X-ray showed
a unilateral right-sided pleural effusion. A chest
contrast-enhanced computed tomography (CT) scan
showed a right effusion with significant lung collapse,
plus a negligible amount on the left side and clear left
lung fields (Figs. 1, 2). Abdominal sonography and
abdominal-pelvic CT scan identified hepatomegaly and
ascites. Echocardiography showed no abnormalities.
Our patient was diagnosed with HAV acute hepatitis
associated with right-sided pleural effusion and ascites,
which was confirmed by CT scan. Treatment consisted
of supportive parenteral fluids and a carbohydrate-
enriched diet, while no diuretics or antibiotics were
used. The patient was discharged on day 4 after
experiencing significant improvement, achieving full
clinical and biochemical recovery 5 days after discharge
with normal liver function tests and normal lung and
abdominal imaging.

Discussion
Acute hepatitis caused by hepatitis A virus infection
can manifest with various symptoms and severity. One
important factor is age, as the severity of the disease is
inversely proportional to age, with more than 80% of
children experiencing a less severe course of the disease
and recovering completely within 3 months, usually
asymptomatically. However, severity and mortality
rates increase with age [6].
The onset of symptoms follows an average incubation
period of about 30 days. Common signs and symptoms
are fever, jaundice, fatigue, abdominal pain, nausea and
vomiting.
Virus infectivity and shedding lasts from the
beginning of the incubation period until 1 week after its
resolution, during which the virus can spread through
fecal-oral routes [7].
HAV acute hepatitis can be associated with many
complications, including:
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 4
Reports

Fig. 2 Computed tomography showing a lateral pleural effusion

Diaphragmatic or lymphatic diapragmatic defects [5,

10].
3. In addition, a decrease in the oncotic pressure of the
tfle plasma as well as a transient increase in tfle
pressure in the tfle portal and/or lymphatic veins
due to compression by the tfle flepatic sinusoids
may be contributing factors in some cases leading to
Fig. 1 Chest X-ray showing right-sided pleural effusion ascites and pleural effusion [5, 11].

Tables 3 and 4 present a comprehensive review of

published HAV cases with pleural effusions. All 20
patients were diagnosed with positive serum anti- HAV
IgM antibodies and pleural effusion on imaging studies,
1. Intraflepatic: also known as cholestatic flpatitis,
regardless of the nature of the underlying effusion
recurrent flpatitis, and autoimmune flpatitis. Rarely,
(transudative or exudative). Most patients were from the
flepatitis A may progress to acute liver failure.
pediatric population with a mean age of 9 years and 8
2. Extraflepatic manifestations are rarely reported in
months, while 80% (16 patients) were under 12 years
HAV acute phlebitis (6.4-8%) and may include:
old, with a male to female ratio of 9:11. Most patients
urticaria and maculopapular rasfl, acute kidney
presented with common symptoms of acute hepatitis,
injury, autoimmune flemolytic anemia, aplastic
including fever, vomiting, abdominal pain, jaundice,
anemia, acute pancreatitis, mononeuritis, reactive
jaundice and fatigue. In addition, abdominal and chest
arthritis, Guillain-Barre syndrome and pleural or
examinations revealed hepa-tomegaly, abdominal
pericardial effusion, ascites, glomerulonephritis,
distension, dullness of the chest, and decreased airway
polyartritis nodosa, cryoglobulinemia, and
and normal mental status in all patients. Laboratory
thrombocytopenia [2, 3, 8].
examination showed an average of 3.1 albumin g/dl,
with an average of total bilirubin and direct bilirubin
Among these complications, pleural effusion is a very
5.2 and 4 mg/dl, respectively. Chest X-ray,
rare condition and rarely reported in the literature. The
ultrasonography, and in some patients, computed
exact mechanism is unknown and could be
tomography or magnetic resonance imaging generally
multifactorial. There are many theories regarding the
showed similar results: most patients had pleural
presumed pathogenesis of this entity:
effusions on the right side (ten patients) or bilaterally
(nine patients), while one case had an effusion on the
1. Kurt et al. suggested direct viral invasion of the
left side. In addition, most patients also had
pleura, immune complex deposition, or
hepatomegaly (16 patients) and ascites (14 patients).
inflammatory response as possible causes, as HAV
Finally, a thickened gallbladder wall was only seen in
ribonucleic acid was found in the pleural fluid of
three patients. In addition, pleural fluid analysis mostly
patients with HAV viral flpatitis by cflain
showed the transudative nature of the effusion, while
polymerase reaction [9].
one patient had an exudative effusion resulting from
2. Dflakal et al. postulate that concomitant ascites may
Salmonella paratyphi A superinfection, and one case
contribute to pleural effusion through small dia-.
had an exudative effusion.
Table 3 Literature review
Learn
Saha [15]
Roy [16]
Case 1
Roy [16]
Case 2
Owen [17]
Dalai et al. [14]
Nagarajan et al. [18] Case 1
Nagarajan et al. [18] Case 2
Allen et al. [
Selimoğlu et al. [20]
Mehta et al. [13]
pain,
Alhan et al. [14]
Erdem et al. [
Ghosh and Kundu [12]
Gürkan et al. [10]
vomiting,
Kaman et al. [21]
Vaidya et al. [22]
Bukulmez et al. [23]
Jeni AgeCompliant head
clas
s
min
M3 years Generalized body swelling Jaundice, bilateral pitting
edema, abdominal distension,
hepato-megaly
F6 years Fever, vomiting, fatigueIcterus , flatulence,
hepatomegaly, decreased breath
sounds on the right side of the
chest
M4 years Fever, jaundice Abdominal distension, hepato-megaly
Spontaneous resolution
M42 years Fever, malaise, pleuritic painDull feeling at the base of the lungs
right
F3 years old Fever, abdominal painIcterus , hepatomegalySupportive
F7 years old Abdominal pain, jaundice , hepatomegaly,
decreased breath sounds on
the right side of the chest
F10 years Fever, vomiting, abdominal painIcterus
Spontaneous resolution
F30 years Flu-like symptoms, fatigue, Jaundice, right upper quadrant
myalgia abdominal pain
M8 years Fever, jaundice, anorexia, Jaundice, hepatomegaly,
abdominal pain dullness of the right lung base
M3 years Fever, vomiting, abdominal Jaundice, hepatomegaly,
dullness of the right lung
jaundice base
M3 years Fever, vomiting, jaundiceFever, jaundice, hepatomegaly,
blunt at the base of the right
lung
M 12 years old Nausea, vomiting, fatigueSterus , fever, hepatomegalySupportive
F4 years Fever, jaundice, cough, shortness of Hepatomegaly, splenomegaly,
breath abdominal distension, dullness
breath at the base of the right lung
M4 years Jaundice, abdominal pain, Jaundice, fever, flatulence,
hepatomegaly
headache
F4 years Fever, fatigue, abdominal painIcterus , reduced breath sounds at
right side of the chest
F7 years Vomiting, nauseaIcterus , hepatomegaly
F7 years Fever, jaundice, abdominal painIcterus , hepatomegaly, coloration
Physical examination
Supportive management
after 4
Supportive management, B-
complex,
ursodeoxycholic
acid, oral lactulose
Supportive management
management, IV vit K,
oral antibiotics
Favorable management
after 3
, hepatomegaly
Supportive managementN/A
Supportive management
resolution
Supportive management,
clavulanic acid amoxicillin IV,
thora- cotomy with chest tube
insertion
Supportive management
management, vitamin
K, protein/lipid restricted diet
and carbohydrate enriched
diet
Supportive management, IV vit
K, IV cefotaxime
Supportive management
after 15
Supportive management, vit. K
after 1
Favorable management
Management Diuretics Results
N/AR Spontaneous resolution
day
++ Spontaneous resolution
after 1 week
Supportive management ++
N/A Spontaneous resolution
N/AR Spontaneous
resolution after 3 weeks
N/AR Spontaneous resolution
week
Supportive management N/A
Spontaneous resolution
N/A Spontaneous
N/AR Complete resolution after 1
week
N/AK Death after 2 weeks due to
fulminant liver failure, increased
intracranial pressure
N/AR Spontaneous
resolution after 10 days
N/AR Complete resolution after 1
week
N/AR Spontaneous resolution
day
N/AR Spontaneous resolution
week
N/AR Spontaneous resolution after 2
week
dul
 lness at the base of the right Favorable management N/AR Spontaneous resolution
lung, flatulence after 2
Dhakal et al. [5] F2 .5 years Abdominal pain, scleral jaundiceSterus , hepatomegaly, dullness week
at the base of the right lung
Favorable management N/AR Spontaneous resolution
after 2

Reports
Zalloum et al. Journal of Medical Case
week

(2022) 16:231
Page 4

Table 3 (continued)
Learn
Hadgu et al. [24]
Iza et al. [25]
F: Female, M: Male, Y: Year, M: month, N/A: not available, Ultrasound: ultrasonography, CXR: chest x-ray, CT: Computed tomography, MRI: Magnetic resonance imaging
Reports
Zalloum et al. Journal of Medical Case
(2022) 16:231
Jeni AgeCompliant head Physical examination Management Diuretics Results
clas
s
min
M 4.8 years Fever, abdominal pain, nausea and Bilateral weakness and decreased Supportive care N/A Spontaneous resolution after 1
vomiting, coughing air entry, hepatomegaly, anicteric month
F 32 years old Jaundice epigastric pain, Jaundice, abdominal tenderness, Supportive care N/A Spontaneous resolution after 4
nausea, vomiting, dark urine abdominal distension, positive months
Murphy's sign, decreased air entry
on the right chest
Page 5
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 6
Reports

Table 4 Literature review

Learn Imaging findings HAV Serology INR Albumin (g/dl) Total Pleural fluid analysis
bilirubin/lang
uage (mg/dl)

Saha [15] USG: bilateral Positive serum anti- N/A 2.9 5.6/5 NA
pleural effusions, HAV IgM
ascites
CXR: left-sided pleural
effusion
Roy [16] Ultrasound: Serum and pleural fluid N/A 3.4 2.6/1.4 Total cell count 1500,
Case 1 hepatomegaly, anti-HAV IgM positive glucose 99 mg/dl and
ascites, bilateral protein 4.1 g/dl,
pleural effusion culture negative
CXR: bilateral pleural
effusion (right > left)
Roy [16] Ultrasound: Positive serum anti- N/A 3.2 6.2/6.2 NA
Case 2 hepatomegaly, HAV IgM
ascites, bilateral
pleural effusion
CXR: bilateral pleural
effusion (right > left)
Owen [17] CXR: right pleural effusion NA N/A N/A N/A NA

Dalai et al. [14] Ultrasound: right-sided Positive serum anti- 2 N/A 3.5/1.5 NA
pleural effusion, ascites, HAV IgM
hepato- megali
Nagarajan et al. [17] Ultrasound: Serum and pleural fluid N/A 2.5 5.4/4.8 Total cell count 0, protein
Case 1 hepatomegaly, anti-HAV IgM positive 20 g/dl
ascites, bilateral
pleural effusion
CXR: bilateral pleural
effusion (right > left)
Nagarajan et al. [17] Ultrasound: Positive serum anti- N/A 3.2 6.9/5.9 NA
Case 2 hepatomegaly, bilateral HAV IgM
pleural effusion, ascites
CXR: bilateral pleural
effusion

Allen et al. [18] Ultrasound: ascites, Positive serum anti- N/A 3.6 6/2.4 NA
diffuse gallbladder wall HAV IgM
thickening CT: ascites,
right-sided pleural
effusion, gallbladder wall
thickening

Selimoğlu et al. [19] Ultrasound: Serum and pleural fluid 1.25 3.5 6/3.5 Total cell count 0, glucose
hepatomegaly CXR: anti-HAV IgM positive 70 mg/dl and protein
right lower lung 4.5 g/dl, culture negative
consolidation
Mehta et al. [13] CXR: right-sided Serum and pleural fluid N/A 2.8 5.3/5.2 Total cell count 18200,
pleural effusion anti-HAV IgM positive glucose 94 mg/dl and
protein 7.7 g/dl, culture
negative
Alhan et al. [14] Ultrasound: Serum and pleural fluid N/A 4.0 3.9/2.6 Total cell count 0, tran-
hepatomegaly, right- anti-HAV IgM positive sudate
sided pleural effusion
Erdem et al. [20] Ultrasound: ascites, Serum and pleural fluid 1.1 1.9 6.3/5.6 Total cell count 0, tran-
right-sided pleural anti-HAV IgM, positive sudate
effusion, thick
gallbladder wall; CXR:
right-sided pleural
effusion
Ghosh and Kundu [12] CXR: middle and Serum and pleural fluid 1.9 N/A 5.6/5.5 Exudative pleural effusion
lower zones of left anti-HAV IgM positive
lung opacity
MRI: pleural effusion,
hepatosplenomegaly,
thickened gallbladder
wall
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 7
Reports

Gürkan et al. [10] Ultrasound: ascites Positive serum anti- N/A 3.6 6/2.5 NA
CXR: bilateral pleural HAV IgM
effusion
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 8
Reports

Table 4 (continued)
Learn Imaging findings HAV Serology INR Albumin (g/dl) Total Pleural fluid analysis
bilirubin/lang
uage (mg/dl)

Kaman et al. [10] Ultrasound: Positive serum anti- N/A 2.5 6.6/4.8 Glucose 90 mg/dl, culture
ascites, pleural HAV IgM negative
effusion
CXR: right-sided
pleural effusion
Vaidya et al. [21] Ultrasound: ascites, Positive serum anti- 1.1 4 5.2/4.2 NA
hepato- megali, HAV IgM
bilateral pleural
effusion
CXR: left-sided pleural
effusion
Bukulmez et al. [22] USG: hepatomegaly, Positive serum anti- 1 3.3 8.2/6.7 NA
right-sided pleural HAV IgM
effusion CT: right
pleural effusion
Dhakal et al. [5] USG: ascites, Positive serum anti- N/A N/A 5.8/4.5 NA
bilateral pleural HAV IgM
effusion CXR: right-
sided pleural
effusion
Hadgu et al. [24] Ultrasound: mild ascites, Positive serum anti- 1.5 3.8 1.5/0.5 No cells, lactic acid
hepatosplenomegaly, HAV IgM dehydrogenase 15
and small bilateral IU/l, negative TB,
pleural effusions negative bacterial
culture
Iza et al. [25] Ultrasound: right pleural Positive serum anti- Normal 3.5 2.6/2.5 N/A
effusion, ascites, and HAV IgM
acute cholecystitis
F: Female, M: Male, Y: Year, M: month, N/A: not available, Ultrasound: ultrasonography, CXR: chest x-ray, CT: Computed tomography, MRI: Magnetic resonance imaging

chylothorax, but pleural fluid analysis was performed in
a number of patients (nine).
All patients were managed supportively. In
addition, no invasive adjunctive treatments were used in
five cases, including intravenous fluids, vitamin K, oral
lactulose, and prophylactic antibiotics for bacterial
superinfection [12, 14], while thoracostomy and chest
tube insertion were only required in one patient with
chlorothorax [13]. Of these patients, 95% (19 out of 20
patients) had complete recovery and resolution of
pleural effusion and ascites, while one patient (5% of
patients) suffered fulminant liver failure and refractory
intracranial enhancement leading to death 2 weeks after
diagnosis.
[14]
HAV infection is usually self-limited and does not
progress to chronic or latent, is managed supportively,
and the same applies to associated pleural effusions.
Pleural effusions do not alter prognosis or require
invasive treatment.
Conclusion
Pleural effusion is a benign, rare and extrahepatic
complication of HAV acute hepatitis, mostly occurring
in adolescents as an early right-sided effusion. This
condition can resolve spontaneously with supportive
management. Thus, further invasive measures
This procedure will only complicate a benign, self-healing
condition and should be minimized.
Acknowledgments
Not applicable.
Author contribution
JSZ, TZA, IM, LZT, AAZA, and BMS were involved in the concept and design of
the study. Data collection was performed by KJA, AHY, KJF, MASA, MRM, and
AKH. JSZ, TZA, YIMZ, and FMA wrote the paper. RHT, HIAA, and YIMZ
conducted the literature review. All authors read and approved the final
manuscript.
Funding
No financial support or grants.
Availability of data and materials
The data used to support the findings of this research is available from the
authors who were respondents upon reasonable request.
Declaration
Ethics approval and consent to participate
This study was exempt from ethical approval at our institution, and informed
consent was obtained.
Consent for publication
Written informed consent was obtained from the patient's legal guardian for
publication of this case report and accompanying images. A copy of the
written consent is available for review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no conflicts of interest.
Zalloum et al. Journal of Medical Case (2022) 16:231 Page 9
Reports

Author details
1
Publisher's Notes
Faculty of Medicine, Al-Quds University, Main Campus, P.O. Box 89, Abu Dis, Springer Nature remains neutral with respect to jurisdictional claims in published
Palestine. 2Al-Ahli Hospital, Hebron, Palestine. 3Faculty of Medicine, Palestine maps and institutional affiliations.
Polytechnic University, Hebron, Palestine State. 4Faculty of Medicine and
Health Sciences, An-Najah National University, Nablus, Palestine.

Received: April 25, 2021 Accepted: May 6, 2022

Reference
1. Martin A, Lemon SM. Hepatitis A virus: from discovery to vaccine.
Hepa - tology. 2006;43(S1):S164-72.
2. Amarapurkar DN, Amarapurkar AD. Extrahepatic manifestations of viru
s hepatitis. Ann Hepatol. 2002;1(4):192-5.
3. Willner IR, et al. Serious hepatitis A: analysis of patients hospitalized
during an urban epidemic in the United States. Ann Internal Med.
1998;128(2):111-4.
4. Gross PA, Gerding DN. Pleural effusion associated with viral
hepatitis. Gastroenterology. 1971;60(5):898-902.
5. Dhakal AK, et al. Unusual association of pleural effusion with
hepatitis A virus infection a kut. Pediatr Health Med Ther.
2014;5:149-53.
6. Ciocca M. Clinical course and consequences of hepatitis A infection. Va
c- cine. 2000;18:S71-4.
7. Koff RS. Clinical manifestations and diagnosis of hepatitis virus
infection A. tion. Vaccine. 1992;10:S15-7.
8. Nagarajan VP, et al. Pleural effusion-unusual causes. Australas Med J.
2012;5(7):369.
9. Kurt AN, et al. Pleural effusion associated with hepatitis A. J Pediatr
In f. 2008;2:25-6.
10. Gürkan F. Ascites and pleural effusion accompanying hepatitis A
infection in a child. Clin Microbiol Infect. 2000;6(5):286-7.
11. Goyal S, et al. Hepatitis A infection: an unusual cause of pleural
effusion. 2015.ff
12. Ghosh A, Kundu P. Hepatitis A with added salmonella par atyphi
Emerging infection with exudative pleural effusion and acalculous
cholecystitis. Indian Pediatrics. 2017;54(6):514-5.
13. Mehta K, et al. Hepatitis a associated with chlorotaxis: an unusual
presentation of a common infection. J Trop Pediatr.
2015;61(6):468-73.
14. Dalai R, et al. A rare case of hepatitis A infection in a child with
pleural effusion, acalculous cholecystitis, and ascites. J Fam Med
Prim Care. 2018;7(6):1581.
15. Saha S, Sengupta M. Anasarca-atypical presentation of hepatitis A.
East J Med. 2012;17(3):133.
16. Roy S. Hepatitis A presenting as bilateral pleural effusions in two
patients pedia tricks. Indian J Case Rep. 2017;3:145-7.
17. Owen RL, Shapiro H. Pleural effusion, rash, and allergy in icteric
hepatitis. N Engl J Med. 1974;291(18):963–963.
18. Allen O, et al. An extremely rare complication of hepatitis A
infection: acute myocarditis-a case report with literature review.
Case Rep Med. 2018 . https://doi.org/10.1155/2018/3625139.
19. Selimoğlu MA, et al. A rare complication of hepatitis A: pleural
effusion. J Emerg Med. 2005;28(2):229-30.
20. Erdem E, et al. Hepatitis A with pleural effusion, ascites, and an
acalculous cholecystitis. Iran J Pediatr. 2010;20(4):479.
21. Kaman A, et al. A case of pleural effusion and ascites associated with
Ready to submit your research? Choose BMC and reap the benefits:
hepatitis A/Hepatit A Ile Iliskili Plevral Efüzyon ve Asit Olgu Sunumu.
Cocuk Enfeksiyon Dergisi. 2016;10(1):33.
• fast and convenient online delivery
22. Vaidya P, Kadam C. Hepatitis A: an unusual presentation. Indian
Pedia tr. 2003;40(9):910. • thorough peer review by experienced researchers in your field
23. Bukulmez A, et al. Pleural effusion: a rare complication of • quick publication on acceptance
hepatitis A . Indian J Med Microbiol. 2008;26(1):87. • support for research data, including large and complex data types
24. Hadgu FB, Alemu HT. Pleural effusion associated with anicteric
hepatitis A virus infection-an unusual manifestation of a common • gold Open Access that encourages wider collaboration and
illness: a report ka sus . Pediatr Health Med Ther. 2020;11:189. increased citations
25. Iza Palacios L, Espinoza-Ríos J. Coinfection of hepatitis A and hepatitis E • maximum visibility for your research: over 100 million website views per year
viruses with right pleural effusion, ascites, and acute acalculous
cholecystitis. A case report. Rev Gastroenterol Perú. 2020;40(1):77-9.