Acute hepatitis A complicated by encephalitis: a case report and literature review

Background Hepatitis A is the most common cause of acute hepatitis around the globe, especially in developing countries. It often presents with signs and symptoms related to the gastrointestinal system. However, it rarely presents extrahepatic manifestations, which can be more common in adults than in children. Case presentation We report a unique case of hepatitis A presenting with encephalitis that was resolved conservatively. Before attributing the neurological features to hepatitis A, we had to rule out other etiologies with similar presentations. Clinical discussion Many viruses cause encephalitis, such as herpes simplex virus types 1 and 2, varicella zoster virus and enteroviruses. A few cases of hepatitis A complicated by encephalitis have been reported in the literature. In our case, developing a tonic-clonic seizure with no past seizure history demanded more investigations to exclude other etiologies. Ultimately, clinical signs and laboratory investigations led us to consider hepatitis A as the main cause of the patient’s symptoms of encephalitis. Conclusion Hepatitis A virus may present with extrahepatic manifestations more than expected, so more studies and research should be done to increase physicians’ knowledge of these manifestations, make early diagnosis, and administer the effective treatment. Highlights • Encephalitis is a rare extrahepatic manifestation of HAV. • Encephalitis presenting with a tonic-clonic seizure and loss of consciousness in an icteric patient. • Differential diagnosis is important to exclude other etiologies of encephalopathy.