Acute Pancreatitis as a Rare Extrahepatic Manifestation of Hepatitis: A Case Report

Acute Pancreatitis as a Rare Extrahepatic Manifestation of Hepatitis: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Acute Pancreatitis as a Rare Extrahepatic Manifestation of Hepatitis: A Case Report RAHUL PATIL, PRANAVI KALAKOTA, ANAND DUGAD, AHANAA CHAKRABOURTY This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8300852/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Hepatitis A virus (HAV) infection remains one of the most frequent causes of acute viral hepatitis worldwide, particularly in developing countries where sanitation and hygiene are inadequate. The disease generally follows a benign and self-limiting course, characterized by fever, malaise, jaundice, and elevated liver enzymes. However, rare extrahepatic manifestations can occur, including renal, hematologic, neurologic, and pancreatic involvement. Among these, acute pancreatitis is an unusual but potentially serious complication that may alter the clinical course of hepatitis A infection. We report a case of a 23-year-old previously healthy male who presented with a five-day history of fever and malaise, followed by jaundice, dark urine, and severe epigastric pain radiating to the back, associated with recurrent vomiting. Laboratory findings revealed markedly elevated hepatic transaminases, bilirubin, and pancreatic enzyme levels. Serological testing confirmed acute HAV infection with positive HAV IgM, while tests for hepatitis B, hepatitis C, and HIV were negative. Abdominal ultrasonography demonstrated hepatomegaly with an enlarged, edematous pancreas and no gallstones or biliary obstruction. Contrast-enhanced computed tomography (CECT) confirmed interstitial edematous pancreatitis without necrosis or pseudocyst formation. The patient was managed conservatively with intravenous fluids, proton-pump inhibitors, antiemetics, and analgesics. His symptoms improved gradually, and biochemical parameters normalized by day ten. He was discharged in stable condition and remained asymptomatic on follow-up. This case underscores acute pancreatitis as a rare but important extrahepatic manifestation of HAV infection. Early recognition and supportive therapy are crucial for complete recovery and prevention of complications. Hepatitis A virus (HAV) Acute pancreatitis Extrahepatic manifestation Take Home Message Acute pancreatitis is a rare but reversible extrahepatic complication of hepatitis A. Clinicians must maintain vigilance when patients with HAV infection complain of persistent epigastric pain. Early diagnosis through enzyme testing and imaging, followed by supportive management, ensures excellent outcomes and prevents unnecessary interventions or diagnostic delay. Introduction Hepatitis A virus (HAV), a non-enveloped RNA virus of the Picornaviridae family, is transmitted through the fecal–oral route and remains a major cause of acute viral hepatitis worldwide. Although infection is usually self-limiting, it continues to be a public health challenge in developing nations where sanitation and hygiene remain inadequate 1 . Most infections in children are asymptomatic, but adults often present with malaise, jaundice, and markedly elevated liver enzymes, occasionally leading to transient hepatic dysfunction. While hepatic involvement predominates, HAV can occasionally produce extrahepatic complications involving renal, hematologic, and neurologic systems 2 . Pancreatic involvement is exceptionally rare but clinically important, as it may complicate an otherwise benign infection and cause diagnostic confusion in the acute setting. Acute pancreatitis is an inflammatory process of the pancreas characterized by abdominal pain and elevated serum amylase and lipase. Gallstones and alcohol are the leading causes; however, viral etiologies such as mumps, coxsackievirus, and hepatitis viruses have been reported 3 . Among these, HAV-induced pancreatitis is extremely uncommon, with only sporadic cases documented in literature. The proposed mechanisms include direct viral cytopathic injury, immune-mediated inflammation, or transient obstruction of the pancreatic duct secondary to ampullary edema 4 . The following case highlights acute interstitial pancreatitis associated with hepatitis A infection in a young adult male, emphasizing the need for clinical suspicion, early diagnosis, and supportive management for a favorable outcome. Case Presentation A 23-year-old previously healthy male presented with a five-day history of fever and malaise, followed by yellowish discoloration of the eyes, dark urine, and severe epigastric pain radiating to the back. The pain was continuous and associated with recurrent vomiting and loss of appetite. There was no history of alcohol use, drug intake, trauma, or gallstone disease. On examination, the patient was afebrile, hemodynamically stable, and mildly icteric. Abdominal examination revealed localized epigastric tenderness without guarding, rigidity, or palpable organomegaly. Laboratory investigations demonstrated elevated hepatic transaminases and pancreatic enzymes, as shown in Table 1 . Serum calcium, triglycerides, and renal function were normal. Serologic testing confirmed HAV IgM positivity, while HBsAg, anti-HCV, and HIV were negative, establishing acute hepatitis A infection. Table 1 Laboratory findings Parameter Patient value Reference range Total bilirubin 6.2 mg/dL < 1.2 mg/dL AST 750 U/L < 40 U/L ALT 980 U/L < 45 U/L ALP 165 U/L 40–129 U/L Serum amylase 480 U/L < 120 U/L Serum lipase 690 U/L < 160 U/L Calcium 9.4 mg/dL 8.5–10.5 mg/dL Triglycerides 112 mg/dL < 150 mg/dL Viral markers HAV IgM (+), HBsAg (–), Anti-HCV (–), HIV (–) — Abdominal ultrasonography revealed hepatomegaly and an enlarged, edematous pancreas with no gallstones or biliary dilation. Contrast-enhanced computed tomography (CECT) confirmed interstitial edematous pancreatitis without necrosis or pseudocyst formation. The patient was kept nil per oral and treated conservatively with intravenous fluids, proton-pump inhibitors, antiemetics, and analgesics. No antibiotics were given, as there were no signs of infection or systemic inflammatory response. His symptoms improved steadily, and oral intake was resumed after one week. Serum pancreatic enzyme levels normalized by day ten, and liver parameters improved significantly. He was discharged on day eleven and remained asymptomatic at one-month follow-up, maintaining normal biochemical parameters. Discussion Acute pancreatitis associated with HAV infection is an uncommon but well-documented clinical entity, with fewer than fifty cases reported worldwide 5 . The close temporal association between the onset of hepatitis and pancreatitis in the absence of other causes supports a causal relationship. The pathogenesis likely involves direct viral invasion of pancreatic acinar cells or immune-mediated injury from circulating immune complexes 6 . Khanna et al. 7 first reported hepatitis A–related pancreatitis resolving with conservative therapy. Mishra et al. 8 and Haffar et al. 9 confirmed its rare, mild, and self-limiting nature. Ouyahia et al. 10 similarly documented full recovery after supportive care, reinforcing that HAV-associated pancreatitis usually has a benign course and excellent prognosis with timely management. Although most cases are mild, severe disease can occur in patients with hepatic dysfunction or comorbidities 5 . Clinicians should suspect pancreatitis in hepatitis A patients presenting with persistent abdominal pain or vomiting. Serum amylase and lipase testing, along with ultrasonography or CT imaging, are essential for diagnosis and to rule out other abdominal causes. Treatment is primarily supportive and includes intravenous hydration, electrolyte correction, analgesia, and nutritional management. Antibiotics are unnecessary unless infection is evident. Early recognition prevents complications, shortens hospital stay, and ensures rapid recovery. Our patient’s prompt improvement following conservative therapy reinforces the importance of timely diagnosis and careful monitoring. Conclusion Hepatitis A–associated acute pancreatitis is a rare but clinically relevant extrahepatic manifestation. It should be suspected in patients with hepatitis A who develop persistent abdominal pain and vomiting. Early diagnosis, exclusion of alternative causes, and supportive management usually ensure complete recovery and excellent prognosis. Increased clinician awareness and biochemical evaluation can prevent misdiagnosis and unnecessary interventions. Abbreviations • HAV Hepatitis A virus • HIV Human Immunodeficiency Virus • CECT Contrast Enhanced Computed Tomography • RNA Ribonucleic Acid • HbsAg Hepatitis B Surface Antigen • Anti HCV–Antibody to Hepatitis C Virus • AST Aspartate Aminotransferase • ALT Alanine Aminotransferase • ALP Alkaline Phosphatase • CT imaging Computed Tomography Declarations 1) Ethics approval and consent to participate - Written informed consent was obtained from the participant. 2) Consent for Publication – Written informed Consent for publication was obtained from the participant. The patient and the patient's guardian have been informed about the manuscript and assured that no personal data, such as name, address, or phone number, will be included. They have consented to their medical data being accessed, provided that no personal patient photo is published, and consent is obtained from the patient and the patient's guardian. Hence, we have removed all the data that might reveal patients' personal information other range of age and occupation. Consent was obtained from the patient’s guardian as well the patient as the patient is a young adult. 3) Availability of data and materials: Data will be available after publication. 4) Competing interests: I have no competing Interests as defined by BMC 5) Funding: No funding obtained from any sources 6) Author's contribution: • Dr Rahul Patil: Participated in the clinical management of the patient, performed a literature review, drafted the manuscript and approved the final version for submission. • Dr Kalakota Pranavi (Corresponding Author): Conceptualised the case report, critically revised the manuscript for important intellectual content and helped in drafting the manuscript • Dr Anand Dugad: Assisted in diagnostic evaluation, contributed to literature review and interpretation of microbiological and imaging findings, and participated in manuscript editing and refinement and approved the final draft. • Dr Ahanaa Chakraborty: Contributed to data interpretation, provided pathological and microbiological insight, reviewed the manuscript for accuracy and clarity, and approved the final draft. 7) Acknowledgements: I would like to acknowledge my Mentor, Dr Rahul Patil, who has given me guidance, support and helped me publish the manuscript and Dr Anand Dugad, who has contributed to literature review and editing of the manuscript and unwavering support from my parents K. Rama Koti Reddy and K. Komali. Author Contribution • Dr Rahul Patil: Participated in the clinical management of the patient, performed a literature review, drafted the manuscript and approved the final version for submission.• Dr Kalakota Pranavi (Corresponding Author): Conceptualised the case report, critically revised the manuscript for important intellectual content and helped in drafting the manuscript• Dr Anand Dugad: Assisted in diagnostic evaluation, contributed to literature review and interpretation of microbiological and imaging findings, and participated in manuscript editing and refinement and approved the final draft.• Dr Ahanaa Chakraborty: Contributed to data interpretation, provided pathological and microbiological insight, reviewed the manuscript for accuracy and clarity, and approved the final draft. Acknowledgement I would like to acknowledge my Mentor, Dr Rahul Patil, who has given me guidance, support and helped me publish the manuscript and Dr Anand Dugad, who has contributed to literature review and editing of the manuscript and unwavering support from my parents K. Rama Koti Reddy and K. Komali. References Khanna S, Vij JC. Severe acute pancreatitis due to hepatitis A virus infection in a patient of acute viral hepatitis. Trop Gastroenterol. 2003 Jan-Mar;24(1):25–6. Jain P, Nijhawan S, Rai RR, Nepalia S, Mathur A. Acute pancreatitis in acute viral hepatitis. World J gastroenterology: WJG. 2007;13(43):5741. Moleta DB, Kakitani FT, Lima AS, França JC, Raboni SM. Acute pancreatitis associated with acute viral hepatitis: case report and review of literature. Rev Inst Med Trop Sao Paulo. 2009 Oct-Dec;51(6):349–51. Parenti DM, Steinberg W, Kang P. Infectious causes of acute pancreatitis. Pancreas. 1996;13(4):356–71. Jain P, Nijhawan S, Rai RR, Nepalia S, Mathur A. Acute pancreatitis in acute viral hepatitis. World J Gastroenterol. 2007;13(43):5741–4. Rawla P, Bandaru SS, Vellipuram AR. Review of infectious etiology of acute pancreatitis. Gastroenterol Res. 2017;10(3):153. Khanna S, Vij JC. Acute pancreatitis associated with acute viral hepatitis A. Trop Gastroenterol. 2003;24(1):25–6. PMID: 12974211. Mishra A, Saigal S, Gupta R, Sarin SK. Acute pancreatitis associated with viral hepatitis: a report of six cases with review of literature. Am J Gastroenterol. 1999;94(8):2292–5. PMID: 10445566. Haffar S, Bazerbachi F, Prokop L, Watt KD, Murad MH, Chari ST. Frequency and prognosis of acute pancreatitis associated with fulminant or non-fulminant acute hepatitis A: a systematic review. Pancreatology. 2017;17(2):166–75. 10.1016/j.pan.2017.02.008 . Ouyahia A. Moderately severe acute pancreatitis: an unusual manifestation of hepatitis A. Afr J Med Case Rep. 2014;2(3):024–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 31 Mar, 2026 Reviews received at journal 28 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers invited by journal 29 Jan, 2026 Editor assigned by journal 29 Jan, 2026 Editor invited by journal 21 Jan, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 20 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8300852","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":583533352,"identity":"76c46433-2a1b-4fad-b5f1-bcbc5ea1e0c7","order_by":0,"name":"RAHUL PATIL","email":"","orcid":"","institution":"Dr. D.Y. Patil Vidyapeeth, Pune","correspondingAuthor":false,"prefix":"","firstName":"RAHUL","middleName":"","lastName":"PATIL","suffix":""},{"id":583533358,"identity":"b9d7d6e9-7f43-4488-886d-f9b6783bf984","order_by":1,"name":"PRANAVI KALAKOTA","email":"data:image/png;base64,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","orcid":"","institution":"Dr. D.Y. 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Patil Vidyapeeth, Pune","correspondingAuthor":false,"prefix":"","firstName":"AHANAA","middleName":"","lastName":"CHAKRABOURTY","suffix":""}],"badges":[],"createdAt":"2025-12-07 15:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8300852/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8300852/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101753789,"identity":"ea59e205-cc58-4816-abd2-64ab6265499a","added_by":"auto","created_at":"2026-02-03 10:40:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":295935,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8300852/v1/deb5d82c-177f-4253-95c0-7cf27c196091.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAcute Pancreatitis as a Rare Extrahepatic Manifestation of Hepatitis: A Case Report\u003c/p\u003e","fulltext":[{"header":"Take Home Message","content":"\u003cp\u003eAcute pancreatitis is a rare but reversible extrahepatic complication of hepatitis A. Clinicians must maintain vigilance when patients with HAV infection complain of persistent epigastric pain. Early diagnosis through enzyme testing and imaging, followed by supportive management, ensures excellent outcomes and prevents unnecessary interventions or diagnostic delay.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eHepatitis A virus (HAV), a non-enveloped RNA virus of the \u003cem\u003ePicornaviridae\u003c/em\u003e family, is transmitted through the fecal\u0026ndash;oral route and remains a major cause of acute viral hepatitis worldwide. Although infection is usually self-limiting, it continues to be a public health challenge in developing nations where sanitation and hygiene remain inadequate \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Most infections in children are asymptomatic, but adults often present with malaise, jaundice, and markedly elevated liver enzymes, occasionally leading to transient hepatic dysfunction.\u003c/p\u003e \u003cp\u003eWhile hepatic involvement predominates, HAV can occasionally produce extrahepatic complications involving renal, hematologic, and neurologic systems \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Pancreatic involvement is exceptionally rare but clinically important, as it may complicate an otherwise benign infection and cause diagnostic confusion in the acute setting.\u003c/p\u003e \u003cp\u003eAcute pancreatitis is an inflammatory process of the pancreas characterized by abdominal pain and elevated serum amylase and lipase. Gallstones and alcohol are the leading causes; however, viral etiologies such as mumps, coxsackievirus, and hepatitis viruses have been reported \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Among these, HAV-induced pancreatitis is extremely uncommon, with only sporadic cases documented in literature.\u003c/p\u003e \u003cp\u003eThe proposed mechanisms include direct viral cytopathic injury, immune-mediated inflammation, or transient obstruction of the pancreatic duct secondary to ampullary edema \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The following case highlights acute interstitial pancreatitis associated with hepatitis A infection in a young adult male, emphasizing the need for clinical suspicion, early diagnosis, and supportive management for a favorable outcome.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 23-year-old previously healthy male presented with a five-day history of fever and malaise, followed by yellowish discoloration of the eyes, dark urine, and severe epigastric pain radiating to the back. The pain was continuous and associated with recurrent vomiting and loss of appetite. There was no history of alcohol use, drug intake, trauma, or gallstone disease.\u003c/p\u003e \u003cp\u003eOn examination, the patient was afebrile, hemodynamically stable, and mildly icteric. Abdominal examination revealed localized epigastric tenderness without guarding, rigidity, or palpable organomegaly.\u003c/p\u003e \u003cp\u003eLaboratory investigations demonstrated elevated hepatic transaminases and pancreatic enzymes, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Serum calcium, triglycerides, and renal function were normal. Serologic testing confirmed HAV IgM positivity, while HBsAg, anti-HCV, and HIV were negative, establishing acute hepatitis A infection.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLaboratory findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference range\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal bilirubin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.2 mg/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1.2 mg/dL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e750 U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 U/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e980 U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;45 U/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165 U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u0026ndash;129 U/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum amylase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e480 U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;120 U/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum lipase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e690 U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;160 U/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.4 mg/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u0026ndash;10.5 mg/dL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglycerides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 mg/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;150 mg/dL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViral markers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHAV IgM (+), HBsAg (\u0026ndash;), Anti-HCV (\u0026ndash;),\u003c/p\u003e \u003cp\u003eHIV (\u0026ndash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAbdominal ultrasonography revealed hepatomegaly and an enlarged, edematous pancreas with no gallstones or biliary dilation. Contrast-enhanced computed tomography (CECT) confirmed interstitial edematous pancreatitis without necrosis or pseudocyst formation.\u003c/p\u003e \u003cp\u003eThe patient was kept nil per oral and treated conservatively with intravenous fluids, proton-pump inhibitors, antiemetics, and analgesics. No antibiotics were given, as there were no signs of infection or systemic inflammatory response. His symptoms improved steadily, and oral intake was resumed after one week. Serum pancreatic enzyme levels normalized by day ten, and liver parameters improved significantly. He was discharged on day eleven and remained asymptomatic at one-month follow-up, maintaining normal biochemical parameters.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAcute pancreatitis associated with HAV infection is an uncommon but well-documented clinical entity, with fewer than fifty cases reported worldwide \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The close temporal association between the onset of hepatitis and pancreatitis in the absence of other causes supports a causal relationship. The pathogenesis likely involves direct viral invasion of pancreatic acinar cells or immune-mediated injury from circulating immune complexes \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eKhanna et al. \u003csup\u003e7\u003c/sup\u003e first reported hepatitis A\u0026ndash;related pancreatitis resolving with conservative therapy. Mishra et al. \u003csup\u003e8\u003c/sup\u003e and Haffar et al. \u003csup\u003e9\u003c/sup\u003e confirmed its rare, mild, and self-limiting nature. Ouyahia et al.\u003csup\u003e10\u003c/sup\u003e similarly documented full recovery after supportive care, reinforcing that HAV-associated pancreatitis usually has a benign course and excellent prognosis with timely management.\u003c/p\u003e \u003cp\u003eAlthough most cases are mild, severe disease can occur in patients with hepatic dysfunction or comorbidities \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Clinicians should suspect pancreatitis in hepatitis A patients presenting with persistent abdominal pain or vomiting. Serum amylase and lipase testing, along with ultrasonography or CT imaging, are essential for diagnosis and to rule out other abdominal causes.\u003c/p\u003e \u003cp\u003eTreatment is primarily supportive and includes intravenous hydration, electrolyte correction, analgesia, and nutritional management. Antibiotics are unnecessary unless infection is evident. Early recognition prevents complications, shortens hospital stay, and ensures rapid recovery. Our patient\u0026rsquo;s prompt improvement following conservative therapy reinforces the importance of timely diagnosis and careful monitoring.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHepatitis A\u0026ndash;associated acute pancreatitis is a rare but clinically relevant extrahepatic manifestation. It should be suspected in patients with hepatitis A who develop persistent abdominal pain and vomiting. Early diagnosis, exclusion of alternative causes, and supportive management usually ensure complete recovery and excellent prognosis. Increased clinician awareness and biochemical evaluation can prevent misdiagnosis and unnecessary interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; HAV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHepatitis A virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; HIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; CECT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContrast Enhanced Computed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; RNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRibonucleic Acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; HbsAg\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHepatitis B Surface Antigen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; Anti\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHCV\u0026ndash;Antibody to Hepatitis C Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; AST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAspartate Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; ALT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlanine Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; ALP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlkaline Phosphatase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026bull; CT imaging\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e1) Ethics approval and consent to participate - Written informed consent was obtained from the participant.\u003c/p\u003e \u003cp\u003e2) Consent for Publication \u0026ndash; Written informed Consent for publication was obtained from the participant. The patient and the patient's guardian have been informed about the manuscript and assured that no personal data, such as name, address, or phone number, will be included. They have consented to their medical data being accessed, provided that no personal patient photo is published, and consent is obtained from the patient and the patient's guardian. Hence, we have removed all the data that might reveal patients' personal information other range of age and occupation.\u003c/p\u003e \u003cp\u003eConsent was obtained from the patient\u0026rsquo;s guardian as well the patient as the patient is a young adult.\u003c/p\u003e \u003cp\u003e3) Availability of data and materials: Data will be available after publication.\u003c/p\u003e \u003cp\u003e4) Competing interests: I have no competing Interests as defined by BMC\u003c/p\u003e \u003cp\u003e5) Funding: No funding obtained from any sources\u003c/p\u003e \u003cp\u003e6) Author's contribution:\u003c/p\u003e \u003cp\u003e\u0026bull; Dr Rahul Patil: Participated in the clinical management of the patient, performed a literature review, drafted the manuscript and approved the final version for submission.\u003c/p\u003e \u003cp\u003e\u0026bull; Dr Kalakota Pranavi (Corresponding Author): Conceptualised the case report, critically revised the manuscript for important intellectual content and helped in drafting the manuscript\u003c/p\u003e \u003cp\u003e\u0026bull; Dr Anand Dugad: Assisted in diagnostic evaluation, contributed to literature review and interpretation of microbiological and imaging findings, and participated in manuscript editing and refinement and approved the final draft.\u003c/p\u003e \u003cp\u003e\u0026bull; Dr Ahanaa Chakraborty: Contributed to data interpretation, provided pathological and microbiological insight, reviewed the manuscript for accuracy and clarity, and approved the final draft.\u003c/p\u003e \u003cp\u003e7) Acknowledgements: I would like to acknowledge my Mentor, Dr Rahul Patil, who has given me guidance, support and helped me publish the manuscript and Dr Anand Dugad, who has contributed to literature review and editing of the manuscript and unwavering support from my parents K. Rama Koti Reddy and K. Komali.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e\u0026bull; Dr Rahul Patil: Participated in the clinical management of the patient, performed a literature review, drafted the manuscript and approved the final version for submission.\u0026bull; Dr Kalakota Pranavi (Corresponding Author): Conceptualised the case report, critically revised the manuscript for important intellectual content and helped in drafting the manuscript\u0026bull; Dr Anand Dugad: Assisted in diagnostic evaluation, contributed to literature review and interpretation of microbiological and imaging findings, and participated in manuscript editing and refinement and approved the final draft.\u0026bull; Dr Ahanaa Chakraborty: Contributed to data interpretation, provided pathological and microbiological insight, reviewed the manuscript for accuracy and clarity, and approved the final draft.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI would like to acknowledge my Mentor, Dr Rahul Patil, who has given me guidance, support and helped me publish the manuscript and Dr Anand Dugad, who has contributed to literature review and editing of the manuscript and unwavering support from my parents K. Rama Koti Reddy and K. Komali.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhanna S, Vij JC. Severe acute pancreatitis due to hepatitis A virus infection in a patient of acute viral hepatitis. Trop Gastroenterol. 2003 Jan-Mar;24(1):25\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain P, Nijhawan S, Rai RR, Nepalia S, Mathur A. Acute pancreatitis in acute viral hepatitis. World J gastroenterology: WJG. 2007;13(43):5741.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoleta DB, Kakitani FT, Lima AS, Fran\u0026ccedil;a JC, Raboni SM. Acute pancreatitis associated with acute viral hepatitis: case report and review of literature. Rev Inst Med Trop Sao Paulo. 2009 Oct-Dec;51(6):349\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParenti DM, Steinberg W, Kang P. Infectious causes of acute pancreatitis. Pancreas. 1996;13(4):356\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain P, Nijhawan S, Rai RR, Nepalia S, Mathur A. Acute pancreatitis in acute viral hepatitis. World J Gastroenterol. 2007;13(43):5741\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRawla P, Bandaru SS, Vellipuram AR. Review of infectious etiology of acute pancreatitis. Gastroenterol Res. 2017;10(3):153.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhanna S, Vij JC. Acute pancreatitis associated with acute viral hepatitis A. Trop Gastroenterol. 2003;24(1):25\u0026ndash;6. PMID: 12974211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMishra A, Saigal S, Gupta R, Sarin SK. Acute pancreatitis associated with viral hepatitis: a report of six cases with review of literature. Am J Gastroenterol. 1999;94(8):2292\u0026ndash;5. PMID: 10445566.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaffar S, Bazerbachi F, Prokop L, Watt KD, Murad MH, Chari ST. Frequency and prognosis of acute pancreatitis associated with fulminant or non-fulminant acute hepatitis A: a systematic review. Pancreatology. 2017;17(2):166\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pan.2017.02.008\u003c/span\u003e\u003cspan address=\"10.1016/j.pan.2017.02.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuyahia A. Moderately severe acute pancreatitis: an unusual manifestation of hepatitis A. Afr J Med Case Rep. 2014;2(3):024\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis A virus (HAV), Acute pancreatitis, Extrahepatic manifestation","lastPublishedDoi":"10.21203/rs.3.rs-8300852/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8300852/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHepatitis A virus (HAV) infection remains one of the most frequent causes of acute viral hepatitis worldwide, particularly in developing countries where sanitation and hygiene are inadequate. The disease generally follows a benign and self-limiting course, characterized by fever, malaise, jaundice, and elevated liver enzymes. However, rare extrahepatic manifestations can occur, including renal, hematologic, neurologic, and pancreatic involvement. Among these, acute pancreatitis is an unusual but potentially serious complication that may alter the clinical course of hepatitis A infection.\u003c/p\u003e \u003cp\u003eWe report a case of a 23-year-old previously healthy male who presented with a five-day history of fever and malaise, followed by jaundice, dark urine, and severe epigastric pain radiating to the back, associated with recurrent vomiting. Laboratory findings revealed markedly elevated hepatic transaminases, bilirubin, and pancreatic enzyme levels. Serological testing confirmed acute HAV infection with positive HAV IgM, while tests for hepatitis B, hepatitis C, and HIV were negative. Abdominal ultrasonography demonstrated hepatomegaly with an enlarged, edematous pancreas and no gallstones or biliary obstruction. Contrast-enhanced computed tomography (CECT) confirmed interstitial edematous pancreatitis without necrosis or pseudocyst formation.\u003c/p\u003e \u003cp\u003eThe patient was managed conservatively with intravenous fluids, proton-pump inhibitors, antiemetics, and analgesics. His symptoms improved gradually, and biochemical parameters normalized by day ten. He was discharged in stable condition and remained asymptomatic on follow-up. This case underscores acute pancreatitis as a rare but important extrahepatic manifestation of HAV infection. Early recognition and supportive therapy are crucial for complete recovery and prevention of complications.\u003c/p\u003e","manuscriptTitle":"Acute Pancreatitis as a Rare Extrahepatic Manifestation of Hepatitis: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 19:04:27","doi":"10.21203/rs.3.rs-8300852/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-31T08:48:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T16:16:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195543755112302187091958796802123314475","date":"2026-03-24T20:26:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110905597573618549282913926697303031177","date":"2026-03-23T15:27:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T10:15:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339027311653121979649753368086040497738","date":"2026-03-06T20:54:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202959874211533919052744087745237995089","date":"2026-02-06T10:27:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T17:32:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105694924351425811520162016729273290079","date":"2026-02-01T16:08:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T11:57:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T11:06:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-21T06:33:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T16:46:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-01-20T16:34:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"faaacbab-86df-4961-a096-e6b7eb767024","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T13:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 19:04:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8300852","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8300852","identity":"rs-8300852","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}