Hepatitis A infection is known to induce autoimmune hepatitis and autoimmune hemolytic anemia. Here we present a case with autoimmune hepatitis type I and autoimmune hemolytic anemia following hepatitis A virus (HAV) infection.
Case: M.A., a male patient, was brought to the hospital with complaints of jaundice and malaise. Physical examination revealed paleness and icterus. The liver was palpable 5 cm below the costal margin in the midclavicular line; the spleen was palpable 2 cm from the costal margin. Laboratory examination revealed severe anemia, reticulocytosis and direct Coombs' IgG positivity. Liver enzymes, total and conjugated bilirubin and alkaline phosphates levels, total protein and immunglobulin levels were high and prothrombin time elongated. Hepatitis A IgM antibody was found positive, while other hepatitis serologic markers were negative. Anti-smooth muscle antibody (ASMA) was positive in 1/80 titer. With these laboratory findings, the case was diagnosed as autoimmune hepatitis and autoimmune hemolytic anemia induced by hepatitis A infection. Liver histology also supported the diagnosis. Steroid therapy resulted in clinical and laboratory remission. In conclusion, it is important to vaccinate children against hepatitis A infection to protect them from its complications and also from autoimmune diseases induced by this infection.