Acute Benign Pleural Effusion, a Rare Presentation of Hepatitis A Virus

A Case Report and Review of the Literature

Jihad Samer Zalloum; Tareq Z. Alzughayyar; Fawzy M. Abunejma; Ibba Mayadma; Layan Ziad Tomeh; Karim Jamal Abulaila; Asil Husam Yagmour; Khalid Jamal Faris; Mohammed A. S. Aramin; Mo'min Ra'id Mesk; Asala Khalil Hasani; Balqis Mustafa Shawer; Rawand Hisham Titi; Ayat A. Z. Aljuba; Hussam I. A. Alzeerelhouseini; Yousef I. M. Zatari


J Med Case Reports. 2022;16(231) 

In This Article

Abstract and Introduction


Introduction: Hepatitis A virus infections are mostly asymptomatic or mildly symptomatic, and generally this disease has a benign course and resolves spontaneously. However, intrahepatic and rarer extrahepatic manifestations can complicate typical cases of acute hepatitis. Pleural effusion is an extremely rare extrahepatic entity with 20 cases reported in literature.

Case Presentation: We report herein a recent case of both pleural effusion and ascites accompanying hepatitis A infection in a 5-year-old middle eastern child, diagnosed using serological testing and imaging studies, who was treated with supportive management with full resolution after 2 weeks. In addition, we review available literature regarding hepatitis A virus associated with pleural effusion using PubMed and summarize all reported cases in a comprehensive table.

Results: Literature contains 20 reported cases of serology-confirmed hepatitis A virus presenting with pleural effusion, most in the pediatric population with average age at presentation of 9 years 8 months. The majority of reported patients had right-sided pleural effusion (50%) or bilateral effusion (45%), while only 5% presented with pleural effusion on the left side. Hepatomegaly and ascites occurred concurrently in 80% and 70% respectively. Supportive treatment without invasive procedures (except one chylothorax case) yielded complete recovery in 95% of cases, while only one case progressed to fulminant liver failure followed by death.

Conclusion: Acute hepatitis A virus rarely presents with pleural effusion, usually following a benign course with spontaneous resolution in most patients. Pleural effusion does not change the prognosis or require any invasive treatment. Thus, further invasive procedures are not recommended and would only complicate this self-resolving benign condition.


Hepatitis A virus (HAV) is a positive-stranded Ribonucleic acid (RNA) virus that is stable at moderate temperatures and low pH, allowing for prolonged survival in the environment and fecal–oral transmission. It is known to circulate among children, especially in developing countries due to poor hygiene and lack of sanitation.[1] Although hepatitis A is usually asymptomatic or presents with mild symptoms in children, extrahepatic manifestations and, particularly, pleural effusions are rare.[2,3] The first case of pleural effusion caused by hepatitis A as underlying infection was described as early as 1971 by Gross and Gerding,[4] but this association has been scarcely reported in medical literature, with no more than 20 cases.[5] We provide herein a comprehensive literature review of 20 published cases and also report a new case, to clarify this rare entity.