Relapsing hepatitis A. Review of 14 cases and literature survey

Medicine (Baltimore). 1992 Jan;71(1):14-23. doi: 10.1097/00005792-199201000-00002.


We have reviewed our experience with 14 cases of relapsing hepatitis A (RH-A), as well as 68 cases reported in the literature. Relapse occurs in 3 to 20% of patients with acute hepatitis A, and rarely takes the form of a polyphasic disease (multiple relapses). After a stage of typical hepatitis A, remission phase ensues, with partial or complete resolution of clinical and biochemical manifestations. Relapse usually occurs after a short period (usually less than 3 weeks). Relapse is usually clinically milder than the first phase, with variable liver function abnormalities and a tendency toward more marked cholestatic features. Not uncommonly, immune manifestations occur during this phase, including purpura, nephritis, and arthralgia, with common laboratory findings of rheumatoid factor as well as false-positive reaction to HCV-EIA tests. The clinical course in relapsing hepatitis A is almost always benign, and uneventful recovery is the rule with few exceptions. Steroid treatment, first reported in the present series, resulted in marked clinical improvement. Preliminary results suggest that R-HA is associated with a continuing viremia as well as shedding of virus in stools during the relapse phase. The pathogenesis of R-HA probably involves an interaction between persistent viral infection and immune mechanisms responding to the continuing antigenic stimulation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Disease Susceptibility
  • Female
  • Hepatitis A / diagnosis*
  • Hepatitis A / drug therapy
  • Hepatitis A / etiology
  • Hepatovirus / genetics
  • Humans
  • Liver Function Tests
  • Male
  • Prednisone / administration & dosage
  • RNA, Viral / blood
  • Recurrence
  • Serologic Tests


  • RNA, Viral
  • Prednisone