Introduction: Hepatitis may result from various causes, both infectious and non-infectious. Viral hepatitis is caused by several different viruses, named the hepatitis A (HAV), B, C, D and E viruses.
They cause acute, or short-term, viral hepatitis. HAV is spread primarily through food or water contaminated by faeces. Acute viral hepatitis A (AVHA) is usually characterized with symptoms of nausea, abdominal pain, fatigue, malaise, vomiting, anorexia, very high aminotransferase values (>1000 U/L), hyperbilirubinemia. Severe cases of AVHA may rapidly progress to acute liver failure, marked by poor hepatic synthetic function.
Materials and methods: A 20-year old male with a recent history of infectious mononucleosis visited his general practitioner, complaining of fever, abdominal pain and dark colour of the urine. Upon examination he was forwarded to the Department of Infectious Diseases, Saint Panteleimon Hospital, Yambol, Bulgaria. The patient also complained of fatigue, lack of appetite, nausea and occasional vomiting. The stools were acholic.
Results: Upon physical examination epigastric tenderness and hepatomegaly were determined, the patient was also jaundice in the skin and scleras. The haematology and biochemistry tests showed elevated Erythrocyte sedimentation rate (26mm/h), Bilirubin-total (94.6μmol/l), Bilirubin-direct (67.2μmol/l), Aspartate Aminotransferase (4530), Alanine Aminotransferase (6840), Gamma-Glutamyl Transferase (62), Sodium (140), Creatinine (83), prothrombin time (82.7%). The urine analyse revealed high levels of Bilirubin (++) and Urobilirubin (++).The following medications were administered Glucose solution 5% 500ml followed by Glucose solution 10% 500ml intravenous (3x1), Silymarin 90mg (3x2) per os, Ademetionine 500mg (3x1) intravenous, Ascorbic acid 100mg (3x3) per os, Metoclopramide 10mg intramuscular, Ursodiol 250mg (3x1) per os.
Conclusion: The peculiarity with the ongoing inflammatory process is the cholestatic pathway and the abnormal clinical picture. Possible reason for which could be the intensified aggressiveness and increased resistance of the virus to the appointed ongoing therapy.
