INTRODUCTION Type A hepatitis is an acute, generally self - limited necroinflammatory liver disease, is one frequent cause of foodborne infection, which can cause mild to severe illness. The incubation period is usually 14 - 28 days. Most patient recover fully from infection with lifelong immunity; it does not cause chronic liver disease and the presentation as fulminant hepatitis accounts for 0.5 % of the worldwide mortality due to hepatitis. OBJECTIVE To describe a case of acute liver failure due to type A hepatitis. CASE PRESENTATION Female of 32 years old, with no significant past medical history, who presented at Emergency Department for complain of jaundice, abdominal pain in right hypochondrium. She referred general discomfort, loss of appetite, and diarrheic stools. On arrival, blood chemistry showed mixed pattern alteration, total bilirubin 4.9 mg / dL, direct bilirubin 3.8 mg / dL, indirect bilirubin 1.1 mg / dL, AST 913 U / L, ALT 982 U / L, GGT 230 U / L, DHL 2142 U / L, and FA 175 U / L. During hospitalization, she presented fever, encephalopathy and coluria. Physical examination was significant for somnolence, mild scleral icterus and right upper quadrant abdominal tenderness. Study protocol was initiated to rule out Weil syndrome and other viral etiology hepatitis. Ultrasound of the liver and bile duct reported hepatomegaly and splenomegaly; type B and C hepatitis panel, TORCH panel and Elisa for HIV reported as negatives. Diagnosis of type A hepatitis was confirmed upon report of positive IgM and IgG > 81mUl / ml for type A hepatitis virus. CONCLUSION The course of type A hepatitis is typically more severe in adults than in children. Adult infections will be characterized by diarrhea and hyperbilirrubinemia peaking 7 to 10 days after the onset of jaundice. In the context of the epidemiological paradox, liver failure from type A hepatitis is rare, and is estimated to occur in less than 5 % of cases. The treatment is supportive. Bibliography World Health Organization. (2020). Hepatitis A. October 8, 2020. World Health Organization. Sitio web: https://www.who.int/news-room/fact-sheets/detail/hepatitis-a. Lemon, S. Ott, J. Damm, P. Shouval, D. Type A viral hepatitis: A summary and update on the molecular virology, epidemiology, pathogenesis and prevention. (2018). Journal of hepatology. 68: 167-184. Abutaleb, A. Kottilil, S. Hepatitis A: epidemiology, natural history, unusual clinical manifestations and prevention. (2020). Gastroenterology Clinics of North America. 49: 191–199. doi.org/10.1016/j.gtc.2020.01.002. Desai, A. Kim, A. Management of Hepatitis A in 2020-2021. (2020). Journal of American Medical Association. 1: E1-E2. doi:10.1001/jama.2020.4017. Randazzo, W. Sánchez, G. Hepatitis A infections from food. (2020). Journal of applied microbiology. 1:1-13. doi: 10.1111/jam14727. Razavi, H. Global epidemiology of viral hepatitis. (2020). Gastroenterology Clinics of North America 49: 179–189. doi.org/10.1016/j.gtc.2020.01.001 Arshad, M. Murphy, N. Bangash, M. Acute liver failure. (2020). Clinical Medicine. Royal college of physicians. 20 (5): 505–508. doi: 10.7861/clinmed.2020-0612. Type A Hepatitis Highlights 1.4 million cases per year globally Infections can be sporadic or epidemic Transmission Fecal - oral Foodborne Person to person contact Diagnosis IgM antibodies to HAV Treatment Supportive Classical presentation Children: Asymptomatic Adults: Jaundice, RUQ pain, hyperbilirubinemia, anorexia. Unusual presentation Relapsing hepatitis Prolonged cholestasis Acute liver failure Prevention HAV vaccine Postexposure prophylaxis HAV vaccine HAV immune globulin Epidemiology
