Laboratory profile of HAV (IgG, IgM), HEV, HCV-Ab, HBsAg and HBcAb (IgG,               IgM) were tested by ELISA (enzyme-linked immuno-sorbent assay) via COBAS INTEGRA 400 ? Roche- Diagnostics, to confirm that the child is free from other viral hepatitis. Patients aged from 3-13 years with predominance of male sex [2 females: 9 males]. All patients presented with hepatosplenomegaly and ascites, five of them (about 46.5%) had right sided pleural effusion, one patient had bilateral pleural effusion. All patients also presented with conjugated hyperbilirubinemia, prolonged prothrombin time. All patients had albumin 2.3gm and more (2.3- 3.7gm). Seven patients (63.6%) had albumin less than 3gm, the remaining four patients had albumin more than 3 gm. Two patients (18.1%) were in fulminant hepatitis (FH), with no previous liver disease before (FH presented by coagulopathy and coma grade III, IV). Some changes of serum Na+ level occurred and corrected without any medications and it was not correlated with the presence or the severity of ascites. Ascites was associated with high level of ammonia in 36.3%, positive CRP in 81.8%, and prolonged prothrombin time. Ascites was present in all cases of conjugated hyperbilirubinemia; recovery was the fate of all children. Many authors concluded that, ascites and pleural effusion may exceptionally accompany hepatitis A infection in children, and presumably the same may occur in adults. The occurrence of ascites in such cases may be explained by a transient increase in portal venous or lymphatic pressure due to the compression of hepatic sinusoids. The transport of ascitic fluid through the diaphragmatic lymphatics or direct passage through a diaphragmatic defect may cause pleural effusion (1-4). In our cases no diaphragmatic hernia was found, so pleural effusion might be mostly due to ascetic fluid transported through the diaphragmatic lymphatics. Our conclusion: pleural effusion and ascites may associate acute hepatitis A infection in children, fortunately its appearance, however, does not indicate an unfavorable outcome, and this observation to be studied on large cohort in Egyptian children.

Table 1:  Demographic data and clinical parameters of patients.

Abbreviations:

• M = male,
• F= female
• FH = fulminant hepatitis
• CRP = C-reactive protein
• AFP = alfa feto-protein
• PT = prothrombin time
• CRP = C reactive protein

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