Saria Adnan Sultan, DO1, Sana Saleem, MD1, Petro Shafranyuk, MD2, Mohammed A. Khan, MS, DO3, Mishaal Khan, MD4, Rida Khan, BS5, Lujain Khan, BA6, Faizan Khan, MD2, Ashirf Al-Ghanoudi, MD, MPH, FACG2 1Franciscan Health, Chicago, IL; 2Franciscan Health Olympia Fields, Olympia Fields, IL; 3Franciscan Health Olympia Fields, Chicago, IL; 4Garden City Hospital, Garden City, MI; 5Michigan State University College of Human Medicine, East Lansing, MI; 6Augustana University, Sioux Falls, SD
Introduction: Hepatitis A (Hep A) is a fecal-oral transmitted picornavirus that selectively infects the liver. The course of a Hep A infection usually lasts for 6-8 weeks, and is often a self-limiting illness. However, there is a 10% chance for a prolonged course where the liver function tests and symptoms persist for several months. Hep A is associated with a long lasting IgA response, which has been studied to be a causative agent for prolonged infection. During infection there are significant amounts of intestinal HAV-IgA. Once it enters the bloodstream there is selective intake into the hepatocytes via an IgA specific receptor called ASGPR. This enterohepatic cycling of HAV is what can cause a persistent infection. In this case we present a patient with prolonged Hep A lasting greater than 3 months, which was suspected to be attributed to this mechanism given significantly elevated levels of IgA with the lack of any other potentiating factors.
Case Description/Methods: A 67-year-old male with functional quadriplegia, and chronic sacral decubitus ulcer status post diverting colostomy presented to the ED after his hemoglobin was found to be 5.4. Patient was in a state of multifactorial shock, and underwent urgent endoscopy which was negative for an acute bleed. Throughout his 4 month hospital stay he maintained elevated total bilirubin, LFTs, and diffuse jaundice. Autoimmune workup, hepatitis B and E, and HIV serology were all negative. However the patient had a positive IgM level for Hep A. Patient underwent a liver biopsy which was positive for acute Hep A without the presence of fibrosis. Immunoglobulin workup also showed an IgA level greater than 900. Coupled with worsening renal function IgA nephropathy was suspected, this diagnosis was not confirmed with renal biopsy due to his critical condition. Due to his multiple comorbidities, the family decided to pursue hospice, and he shortly passed afterwards.
Discussion: This case showcases how IgA can explain a prolonged course of Hep A after other contributing factors have been excluded. Prolonged Hep A can be seen in immunocompromised states, chronic liver disease, and in those with additional acute infections. This case highlights how after we excluded several other potential causes of prolonged Hep A, the elevated IgA response supported the enterohepatic cycling prolonging the course of infection as the likely etiology. In conclusion, we hope to illustrate how analyzing immunoglobulin levels can be helpful in assessing prolonged courses of Hepatitis A.
Saria Adnan Sultan indicated no relevant financial relationships.
Sana Saleem indicated no relevant financial relationships.
Petro Shafranyuk indicated no relevant financial relationships.
Mohammed Khan indicated no relevant financial relationships.
Mishaal Khan indicated no relevant financial relationships.
Rida Khan indicated no relevant financial relationships.
Lujain Khan indicated no relevant financial relationships.
Faizan Khan indicated no relevant financial relationships.
Ashirf Al-Ghanoudi indicated no relevant financial relationships.
Saria Adnan Sultan, DO1, Sana Saleem, MD1, Petro Shafranyuk, MD2, Mohammed A. Khan, MS, DO3, Mishaal Khan, MD4, Rida Khan, BS5, Lujain Khan, BA6, Faizan Khan, MD2, Ashirf Al-Ghanoudi, MD, MPH, FACG2. P2486 - IgA-Mediated Mechanisms and Prolonged Hepatitis A Infection: Insights Into the Interplay Between Immune Response and Viral Persistence, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.