Hepatitis A Virus Meningoencephalitis

Sir,

A 10-year-old girl presented with a one-week history of abdominal pain, nausea and dark urine. On admission, she was icteric and drowsy with palpable liver 2 cm below the costal margin. The laboratory tests revealed elevated liver function tests with an aspartate aminotransferase level of 349 IU/L (8-40 IU/L), an alanine aminotransferase level of 1327 IU/L (7-56 IU/L), a gamma glutamyl transferase level of 370 U/L (9-24 U/L), an alkaline phosphatase level of 325 IU/L (30-100 IU/L), a total bilirubin of 3.3 mg/dL (0.2-1.2 mg/dL) and direct bilirubin of 2.2 mg/dL (0.1-0.4 mg/dL). The patient’s plasma ammonia level was 67 mg/dL (15-45 mg/dL). Values of Prothrombin Time (14 seconds), activated Partial Thromboplastin Time (35 seconds) and International normalized ratio (1.12) were within normal ranges. In investigations, an immunoglobulin M (Ig M) antibody against hepatitis A virus (HAV) was positive with negative serological markers for hepatitis B and C viruses. The Widal and Weil Felix tests were negative. Read more...