An Atypical Case of Prolonged Cholestatic Hepatitis Following Acute Hepatitis a Infection and the Role of Corticosteroids: A Case Report

Abstract

Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children and usually follows a benign, self-limited course (Schiff, 1992, Wang et al., 2015, Tong et al., 1995). However, atypical manifestations are increasingly recognized, and prolonged cholestatic hepatitis is an uncommon but clinically important variant that may result in persistent jaundice, severe pruritus, and prolonged morbidity despite preserved liver synthetic function (Gordon et al., 1984, Singh et al., 2019, Schiff, 1992). This report describes a 6-year-old boy with serologically confirmed acute hepatitis A who developed sustained conjugated hyperbilirubinemia, pruritus, and intermittent low-grade fever beyond three weeks of supportive care. Evaluation excluded autoimmune hepatitis, Wilson disease, biliary obstruction, chronic liver disease, and other common infectious etiologies. Because of persistent symptoms and delayed biochemical recovery, oral prednisolone was started at 2 mg/kg/day, following which the child showed rapid clinical improvement and progressive normalization of liver function tests. This case highlights the importance of recognizing prolonged cholestatic hepatitis as a distinct clinical pattern of HAV infection and suggests that short-course corticosteroid therapy may be considered in carefully selected refractory pediatric cases (Chirag and Arun Babu, 2023, Gordon et al., 1984).