背景:甲型肝炎病毒感染大多无症状或轻度症状,一般来说,这种疾病是良性的,可以自发解决。然而,肝内和罕见的肝外表现可使急性肝炎的典型病例复杂化。胸腔积液是一种极其罕见的肝外实体,文献报道20例。
方法:我们在此报告最近一例5岁中东儿童并发甲型肝炎感染的胸腔积液和腹水,诊断使用血清学测试和影像学研究,2周后接受支持性治疗的患者完全消退。此外,我们使用PubMed回顾了有关甲型肝炎病毒与胸腔积液相关的现有文献,并将所有报告病例汇总在一个综合表格中.
结果:文献包含20例血清学证实的甲型肝炎病毒表现为胸腔积液,大多数在儿科人群中,平均年龄为9岁8个月。大多数报告的患者有右侧胸腔积液(50%)或双侧胸腔积液(45%),而只有5%的患者出现左侧胸腔积液。肝肿大和腹水的发生率分别为80%和70%。无侵入性程序的支持性治疗(除了一例乳糜胸病例)在95%的病例中完全恢复。只有一例进展为暴发性肝功能衰竭,随后死亡。
结论:急性甲型肝炎病毒很少出现胸腔积液,通常遵循良性病程,大多数患者自发消退。胸腔积液不会改变预后或需要任何侵入性治疗。因此,不建议进一步的侵入性手术,只会使这种自我解决的良性疾病复杂化。
BACKGROUND: Hepatitis A virus infections are mostly asymptomatic or mildly symptomatic, and generally this disease has a benign course and resolves spontaneously. However, intrahepatic and rarer extrahepatic manifestations can complicate typical cases of acute hepatitis. Pleural effusion is an extremely rare extrahepatic entity with 20 cases reported in literature.
METHODS: We report herein a recent case of both pleural effusion and ascites accompanying hepatitis A infection in a 5-year-old middle eastern child, diagnosed using serological testing and imaging studies, who was treated with supportive management with full resolution after 2 weeks. In addition, we
review available literature regarding hepatitis A virus associated with pleural effusion using PubMed and summarize all reported cases in a comprehensive table.
RESULTS: Literature contains 20 reported cases of serology-confirmed hepatitis A virus presenting with pleural effusion, most in the pediatric population with average age at presentation of 9 years 8 months. The majority of reported patients had right-sided pleural effusion (50%) or bilateral effusion (45%), while only 5% presented with pleural effusion on the left side. Hepatomegaly and ascites occurred concurrently in 80% and 70% respectively. Supportive treatment without invasive procedures (except one chylothorax case) yielded complete recovery in 95% of cases, while only one case progressed to fulminant liver failure followed by death.
CONCLUSIONS: Acute hepatitis A virus rarely presents with pleural effusion, usually following a benign course with spontaneous resolution in most patients. Pleural effusion does not change the prognosis or require any invasive treatment. Thus, further invasive procedures are not recommended and would only complicate this self-resolving benign condition.