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Case Reports in Gastrointestinal Medicine
Volume 2014, Article ID 286914, 5 pages
http://dx.doi.org/10.1155/2014/286914
Case Report

A Rare Presentation of Hepatitis A Infection with Extrahepatic Manifestations

1Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA
2Medicine and Pediatrics, Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA

Received 8 May 2014; Accepted 18 August 2014; Published 14 September 2014

Academic Editor: Haruhiko Sugimura

Copyright © 2014 Geetika Bhatt et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatitis A has a variety of associated extrahepatic manifestations that clinicians should be aware of for early diagnosis and treatment. We report a unique case of hepatitis A presenting with multiple extrahepatic manifestations not previously described in a single patient. A 34-year-old male presented with sudden onset of left sided facial pain, swelling, and skin rash, with diffuse body pains and muscle weakness, and was found to be positive for hepatitis A immunoglobulin M (IgM). He was initially started on antibiotics for concerns of bacterial parotitis but did not show any improvement. A punch biopsy of his mandibular rash and swelling was done which showed lymphohistiocytic infiltration with a few eosinophils. A trial of prednisone resulted in improvement of his symptoms. Clinicians should be aware to look for hepatitis A infection in a patient with atypical clinical picture causing a widespread systemic inflammatory response. Treatment with prednisone may result in resolution.