Annals of Tropical Paediatrics (1999) 19, 391±394 Acute pancreatitis with cholestatic hepatitis: an unusual manifestation of hepatitis A KISHORE S. AGARWAL, JACOB M. PULIYEL, ANN MATHEW, DEEPAK LAHOTI* & RICHA GUPTA Departments of Paediatrics & *Gastroenterology, St Stephen’s Hospital, Delhi, India (Accepted 20 May 1999) Summary Acute hepatitis A infection is an uncommon cause of pancreatitis in children. To date, only four cases have been reported in the paediatric literature. We report a 7-year-old girl with acute pancreatitis associated with hepatitis A infection who made a satisfactory recovery. The report highlights the CT ®ndings including focal necrosis not previously reported. Because of the extreme rarity of the complication, the four previous reports have also been single case reports. This paper reviews all these cases with a view to elucidating the aetiopathogenesis of the pancreatitis. Introduction Only four cases of acute pancreatitis due to hepatitis A viral infection have been reported in children. 1±4 We present a ®fth case who developed pancreatitis during the convalescent phase of cholestatic hepatitis A infection and made a good recovery. Case report A 7-year-old girl was admitted with a 1-month history of jaundice and a 15-day history of pruritis and passing clay-coloured stools. She had had a fever for 5 days and acute abdomi- nal pain with vomiting for 2 days prior to admission. There was no history of recent abdominal trauma, use of medication, worm infestation, exanthematous rash or of anything suggestive of haemolytic disease. Her sibling had devel- oped jaundice at the same time and recovered uneventfully within 2 weeks. On examination she was febrile, conscious and deeply jaundiced. The abdomen was ex- cruciatingly tender. The liver was enlarged 2 cm below the right costal margin in the mid-clavicular line and the span was 7.5 cm. There was no bluish discoloration of the ¯anks or peri-umbilical area. The bowel sounds were markedly reduced. Laboratory investigations showed a serum bilirubin of 5.4 mg/dl (normal 0.2±1.2), direct bilirubin 3.8 mg/dl (normal 0±0.2), aspartate aminotransferase (AST) 195 U/l (normal 20± 40), alanine aminotransferase (ALT) 180 U/l (normal 20±40), serum alkaline phosphatase 780 U/l (normal 145±400) and serum amylase 1560 U/l (normal 35±127). The IgM anti-hep- atitis A virus (HAV) test (ELISA test, Abbot Laboratories, IL, USA) was positive. Hepatitis B surface (HBS) antigen, anti-HBS, anti-HB core IgM, HBeAg, anti-HBe and anti-hepatitis C virus tests (ELISA test, Abbot Laboratories, IL, USA) all proved negative. The anti-hepati- tis E virus IgM test (Gene Laboratories, Sin- Reprint requests to: Dr Kishore S. Agarwal, Department of Paediatrics, St Stephen’s Hospital, Tis Hazari, Delhi±110054, India. Fax: 1 91 11 293 2412; e-mail: puliyel@del6.vsnl.net.in ISSN 0272-4936 print/ISSN 1465-328/online/99/040391-04 Ó 1999 The Liverpool School of Tropical Medicine Carfax Publishing