Rare but real: Unusual manifestations of hepatitis A

Hepatitis A is usually a self-limiting infection in children, commonly presenting with jaundice. However, rare extra-hepatic manifestations may complicate the course, including cardiac and pancreatic involvement. We report two paediatric cases of hepatitis A virus (HAV) infection with such atypical presentations. A 6-year-old boy presented with lethargy, vomiting, and bradycardia; an electrocardiogram revealed complete heart block progressing to Mobitz type I block, with bilateral pleural effusion. Also, a 10-year-old boy presented with acute abdominal pain and was found to have elevated pancreatic enzymes and imaging findings consistent with pancreatitis. Both improved with conservative management. These cases highlight the importance of recognising unusual systemic complications of HAV. They also reinforce the urgent need to integrate hepatitis A vaccination into the national immunisation schedule in India.