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Hepatitis A and vigorous physical activity

1998; Elsevier BV; Volume: 352; Issue: 9124 Linguagem: Inglês

10.1016/s0140-6736(05)60304-2

1474-547X

G de Cells, Jesús Casal, X Latorre, Jonathan B. Angel,

Hepatitis C virus research

A rare course of hepatitis A that Raymond Koff (May 30, p 1643)1Koff RS Hepatitis A.Lancet. 1998; 351: 1643-1649Summary Full Text Full Text PDF PubMed Scopus (243) Google Scholar does not include in his seminar, is long-term hepatitis, in which serum alanine aminotransferase (ALT) is raised for many months without recurrence of the disease,2Wacker WEC Riordan TF Snodgrass PT et al.The Holy Cross hepatitis outbreak: clinical and biochemical abnormalities.Arch Intern Med. 1972; 130: 357-360Crossref PubMed Scopus (17) Google Scholar as seen in relapsing hepatitis. A 31-year-old, previously healthy, white fireman presented at our hospital with malaise, weakness, anorexia, and nausea on Feb 14, 1997. He had not consumed alcohol or taken drugs and had recently travelled to Brazil. He cycled for 60 km, or walked and climbed for 3–4 h every day. On physical examination, he was jaundiced with a slightly enlarged and tender liver. Laboratory values were: ALT 6642 U/L (normal < 41 U/L); aspartate aminotransferase 5040 U/L; total bilirubin 100·89 μmol/L; conjugated bilirubin 86·18 μmol/L; alkaline phosphatase 381·6 IU/L; γ-glutamyl transpeptidase 220·8 U/L; prothrombin time 37%; blood glucose 5·43 mmol/L. Elisa HAV IgM antibodies were positive. Before the onset of illness, ALT had been normal in two routine blood tests. Hepatitis B surface antigen and hepatitis C virus antibodies were negative. An abdominal ultrasound revealed an enlarged homogenous liver. The patient rested in bed until the end of February, after which time he was feeling better, his ATT had decreased to 390 U/L, and he decided to restart his usual vigorous physical activity. On March 27, he had no symptoms of hepatitis A, but ALT had increased to 954 U/L, with normal bilirubin. He reduced his exercise again. 6 months from the onset of illness, hepatitis A virus IgM antibodies were positive, and antinuclear, anti-liver-kidney, hepatitis C virus, hepatitis B core, hepatitis G Ig G, and hepatitis E Ig G were negative. 1 month later, hepatitis A virus IgM antibodies became negative, but serum ATT remained raised for more than 16 months. In a patient with confirmed acute hepatitis A (positive HAV IgM antibodies), the presence of liver-test abnormalities for more than 4 months is troublesome. If relapsing or cholestatic hepatitis are excluded, a simultaneous co-infection by other viruses, as well as autoimmune hepatitis3Vento S Garofano T Di Perri G et al.Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals.Lancet. 1991; 337: 1183-1187Summary PubMed Scopus (251) Google Scholar must be considered. The importance of rest in acute hepatitis A is controversial.4Repsher LH Freebern RK Effects of early and vigorous exercise on recovery from infectious hepatitis.N Eng J Med. 1969; 281: 1393-1396Crossref PubMed Scopus (30) Google Scholar During exercise, hepatic blood flow decreases, and fulminant hepatitis A has been described with vigorous exercise at the start of the illness.5Krikler DM Zilberg B Activity and hepatitis.Lancet. 1966; ii: 1046-1047Abstract Google Scholar In our patient, strenuous physical activity just before the diagnosis of acute hepatitis could have induced an high initial serum ALT value, and restarting his vigorous exercise, which coincided with serum ALT increase, could have contributed to the long duration of the disease. We suggest that vigorous physical activity should be avoided in patients with hepatitis A until liver transaminases are normal.