P2955 - The Unusual Case of Triple Hepatitis Virus Infection; A Case Report

Kaycee Umeoji, MD¹, Uma Yoganathan, MBBS¹, Bryce Parrish, DO¹, Erik Raborn, DO, MPH¹, Bruno Mazza, MD², Pallavi Kamjula, MD^3
1Arnot Ogden Medical Center, Elmira, NY; ²Arnot Health, Elmira, NY; ³Arnot Ogden, Elmira, NY

Introduction: Viral hepatitis is a major disease of public health significance in the United States.Five human hepatitis viruses have been identified to date; of these, four (4) of the viruses have been described as endemic in the United States: Hepatitis A, B, C and D.It has been reported that Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) share the same transmission routes, whereas Hepatitis A Virus (HAV) on the other hand is a virus that is transmitted almost exclusively through the fecal-oral route. We present the case of a young male who presented to the ED with jaundice and was subsequently found to be seropositive for HAV, HBV and HCV.

Case Description/Methods: A 23yr old male with no significant past medical history presented with a 1 week history of jaundice and darkurine.He also reported malaise for >1 month but denied any abdominal pain or distension. His social history revealed he is currently of undomiciled status, occasionally used drugs and has had unprotected sex.Laboratory workup revealed elevated liver transaminases and a hepatitis profile reactive for hepatitis A IgM, hepatitis C antibody and hepatitis B core antibody. Gastroenterology and infectious disease consultations recommended testing for HCV RNA and DNA genotype levels and supportive care for his hepatitis A infection. The patient's liver function labs improved and he was discharged to a homeless shelter with follow-up appointments with the infectious disease specialists.

Discussion: Hepatitis A virus, is a reportable disease that is transmitted by the fecal–oral route.Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a significant proportion of chronic liver disease in the United States and are transmitted through parenteral routes. Limited information exists on treatment of double or triple viral infections because of the lack of understanding of the mechanisms by which hepatotropic viruses interact. It is important to have thorough serological testing of coinfected patients before initiation of antiviral therapy. In conclusion, it has been well established that HBV and HCV are transmitted via blood and body fluids whereas HAV is transmitted through fecal-oral means. The fact that the patient actually tested positive for HAV, HBV and HCV is unusual and rarely reported. Nevertheless the case exemplifies the fact that despite the lack of obvious risk factors or clinical reasoning, testing for all types of the Hepatitis virus is important in patient presenting with symptoms suggestive of viral hepatitis.


Disclosures:


Kaycee Umeoji, MD¹, Uma Yoganathan, MBBS¹, Bryce Parrish, DO¹, Erik Raborn, DO, MPH¹, Bruno Mazza, MD², Pallavi Kamjula, MD³. P2955 - The Unusual Case of Triple Hepatitis Virus Infection; A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.