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Acta Medica Medianae
Vol. 51, No 1, June, 2012

UDK 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)


Correspondence to:

Lidija  Popović Dragonjić

Clinic for Infectious Diseases

Clinical Centre Niš

Dr Zoran Djindjic’s Boulevard 48, 18000 Niš


Case report                                                                       

UDC: 615.874:616.831-008




Atypical, cholestatic form of hepatitis A with an extrahepatic, cutaneous manifestation – a case report


Lidija Popović Dragonjić1,2, Dane Krtinić2, Maja Jovanović1,2, Miodrag Vrbić1,2, Velimir Kostić1,2 and Ivan Dragonjić3

Clinic for Infectious Diseases, Clinical Centre Niš, Niš, Serbia1

University of Niš, Faculty of Medicine, Niš, Serbia2

PharmaSwiss Belgrade, Niš Branch Office, Niš, Serbia3


Hepatitis A sometimes can present through atypical forms and merged extrahepatic manifestations. Most atypical forms include relapsing hepatitis and cholestatic hepatitis. Extrahepatic manifestations of HAV are rare, and include evanescent skin rash and transient arthralgias. A 25-year-old male, previously healthy, developed acute hepatitis. Hepatitis A virus was serologically confirmed. No skin efflorescences were seen at the beginning. Over the course of the illness which extended up to fifteen weeks, bilirubin and aminotransferase levels were continuously highly elevated. Nine weeks after the initial presentation he developed a painless, non-pruritic, purpura-like maculopapular erythematous rash over both lower extremities. Five weeks later, the rash had completely disappeared and the patient’s clinical status much improved. This case demonstrates two unusual and unrelated manifestations: prolonged cholestatic form of hepatitis and cutaneous vasculitis. Possible unusual manifestations of this disease should be a reminder of a brief diagnostic examination, which is usually not done in hepatitis A. Acta Medica Medianae 2012;51(2):31-33.


      Key words: atypical hepatitis A, extrahepatic manifestation