Amrit K. Kamboj et al report the case of a 33-year-old woman with a 10-day history of painless jaundice, decreased appetite, malaise, and pruritus. The patient did not have right upper quadrant pain or weight loss and was not taking any medications. She had a history of methamphetamine use, which was in remission, and she had recently been incarcerated for about 1 month.
Upon arrival to the emergency department, the patient had normal vital signs. However, she had increased levels of alanine aminotransferase (1625 U/L), aspartate aminotransferase (432 U/L), alkaline phosphatase (149 U/L), and total bilirubin (5.3 mg/dL). Ultrasound examination of the gallbladder showed a mildly edematous gallbladder wall without cholelithiasis, distention, or pericholecystic fluid. Her common bile duct was of normal caliber.
A computed tomography scan of the abdomen/pelvis revealed gastric distention without obvious obstructing mass and normal caliber small bowel and colon (see figure). The patient tested positive for IgM against hepatitis A virus, but not hepatitis B surface antigen or core IgM, or hepatitis C virus antibody or HIV antigen or antibody.
An esophagogastroduodenoscopy was performed that showed a large amount of food in a dilated and atonic stomach.
The patient received conservative treatment and her levels of liver enzymes and bilirubin decreased. At the time of discharge from the hospital, she was able to eat soft foods without difficulty. She was educated on taking precautions to avoid transmitting the hepatitis A virus, which she might have acquired during her recent incarceration.
Hepatitis A virus infection is usually a self-limited illness that can lead to liver failure, in rare cases. Common symptoms including nausea, vomiting, jaundice, fever, diarrhea, and abdominal pain. The infection causes increased serum levels of aminotransferases, alkaline phosphatase, and total bilirubin, as in this patient.
The most common route of transmission is the fecal–oral route such as through consumption of contaminated water and food or from person-to-person contact. People can become immune to infection either through prior infection or vaccination.
Gastroparesis refers to delayed emptying of gastric contents when mechanical obstruction has been ruled out. Common causes include diabetes, medications, postoperative complications, and infections. Acute gastroparesis after viral infections can be severe and slow to resolve.