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Case Reports in Medicine
Volume 2018, Article ID 3625139, 6 pages
https://doi.org/10.1155/2018/3625139
Case Report

A Very Rare Complication of Hepatitis A Infection: Acute Myocarditis—A Case Report with Literature Review

1Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
2Oakland University William Beaumont School of Medicine, Rochester, MI, USA

Correspondence should be addressed to Olivia Allen; gro.tnomuaeb@nella.aivilo

Received 28 May 2018; Accepted 13 August 2018; Published 13 September 2018

Academic Editor: Jagdish Butany

Copyright © 2018 Olivia Allen 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 is a common viral infection with a benign course but in rare cases can progress to acute liver failure. It usually presents with abdominal pain, nausea, vomiting, diarrhea, jaundice, anorexia, or asymptomatically, but it can also present atypically with relapsing hepatitis and prolonged cholestasis. In addition, extrahepatic manifestations have been reported, including urticarial and maculopapular rash, acute kidney injury, autoimmune hemolytic anemia, aplastic anemia, acute pancreatitis, mononeuritis, reactive arthritis, glomerulonephritis, cryoglobulinemia, Guillain–Barre syndrome, and pleural or pericardial effusion. A rare manifestation of hepatitis A is acute myocarditis. We report a case of a young woman who presented with “flu-like symptoms” and was found to have severe elevation of liver enzymes due to acute hepatitis A infection. On her 3rd day of admission, the patient developed chest pain and nonspecific electrocardiographic changes. Her troponins rose to 16.4  ng/mL, and a transthoracic echocardiogram revealed global hypokinesis and a depressed ejection fraction at 30%. A CT angiography showed no evidence of significant coronary artery disease. The patient was managed supportively, and symptoms and laboratory findings slowly improved over the next 7 days. Her chest pain resolved and a follow-up echocardiogram showed improved ejection fraction to 45%.