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1 May 2007

Volume 44, Number 9
Clinical Infectious Diseases 2007;44:e73–e77
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4409-00E2$15.00
DOI: 10.1086/513430
MAJOR ARTICLE

Acute Hepatitis with Severe Cholestasis and Prolonged Clinical Course Due to Hepatitis A Virus Ia and Ib Coinfection

Nicola Coppola,1

Domenico Genovese,2

Mariantonietta Pisaturo,1

Stefania Taffon,2

Claudio Argentini,2

Giuseppe Pasquale,1

Caterina Sagnelli,1

Felice Piccinino,1

Maria Rapicetta,2 and

Evangelista Sagnelli1

1Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, and 2Viral Hepatitis Unit, Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy

Background.Acute viral hepatitis due to hepatitis A virus is a self‐limited illness that infrequently has a severe clinical course.

Methods.We analyzed the virological characteristics of acute hepatitis A in a patient with a severe clinical presentation (peak total and conjugated bilirubin levels, 65.5 mg/dL and 40.1 mg/dL, respectively) and a course of disease that lasted 7 months.

Results.Hepatitis A virus sequencing revealed coinfection with 2 subgenotypes of hepatitis A virus (Ia and Ib) as etiological factors of the illness.

Conclusions.Hepatitis A virus Ia and Ib coinfection may have accounted for the prolonged and severe course of illness.

Received 7 November 2006; accepted 27 January 2007; electronically published 28 March 2007.

Reprints or correspondence: Prof. Evangelista Sagnelli, Dept. of Public Medicine, Section of Infectious Diseases, Second University of Naples, c/o Ospedale Gesù e Maria, Via D. Cotugno 1, 80135 Naples, Italy ().
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