Haider Abbas Naqvi, MD, Ashik Pokharel, MBBS, Christopher Haas, MD, PhD MedStar Health, Baltimore, MD
Introduction: Hepatitis A is generally a benign, self-limited viral infection transmitted by the fecal-oral route. Since 2016, there have been over 33,000 reported infections in the United States. Outbreaks have been known to occur in the setting of seafood consumption; oysters have been identified as a main culprit. A few reports have noted extraintestinal manifestations of Hepatitis A, with only a single report noting pericarditis. No cases of pericardial effusion with or without tamponade have been reported.
Case Description/Methods: A 58-year-old male with coronary disease s/p bypass grafting, diverticulitis s/p colostomy with reversal, and diabetes mellitus type 2 presented with several days of constant, crampy left lower quadrant abdominal pain. He had otherwise been in usual health with no new exposures except for consuming a bushel of oysters a couple of days prior to symptom onset. On presentation he was hemodynamically stable. Initial labs demonstrated ALT [1480 U/L], AST [776 U/L], alkaline phosphatase [212 U/L], and D-dimer [5.70 mcg/mL], with a normal lipase and a positive Hepatitis A IgM. CT chest/abdomen/pelvis with IV contrast revealed no pulmonary embolism, a small to moderate pericardial effusion, and edema around the gallbladder without signs of acute cholecystitis. Hospital course complicated by cardiac tamponade, necessitating emergent pericardiocentesis and removal of 600 cc of transudative, dark-brown fluid and negative for ANA, RF, and anti-Scl7, malignant cells, and cultures. Subsequently, requiring pericardial window placement. He was discharged home with a pericardial drain and outpatient echocardiogram demonstrated resolution of the pericardial effusion and in clinic the drain was removed.
Discussion: Acute Hepatitis A infection may present on a spectrum from asymptomatic presentation to acute liver failure. Though primarily presenting with gastrointestinal symptomatology with viral prodrome, extraintestinal manifestations such as autoimmune hemolytic anemia, aplastic anemia, reactive arthritis, Guillain-Barré syndrome, myocarditis and pericardial effusions, have been rarely reported. Acute infection will have positive Hepatitis A IgM in conjunction with elevated transaminases, specifically ALT. The extraintestinal manifestations of Hepatitis viral infections are typically diagnoses of exclusion. Hepatitis induced pericardial effusion will have yellowish orange fluid and the presence of bilirubin on analysis. In the absence of liver failure, Hepatitis A is managed supportively.
Figure: Figure: Presence of moderate pericardial effusion and normal liver morphology on CT scans. Pericardial Effusion and the development of tamponade. Resolution of pericardial effusion on follow-up echocardiogram.
Disclosures:
Haider Abbas Naqvi indicated no relevant financial relationships.
Ashik Pokharel indicated no relevant financial relationships.
Christopher Haas indicated no relevant financial relationships.
Haider Abbas Naqvi, MD, Ashik Pokharel, MBBS, Christopher Haas, MD, PhD. C0624 - Oysters Are Dangerous for Your Liver, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
