Treatment of Prolonged Cholestasis with Systemic Steroid in Acute Hepatitis A: A Case Report

Acute hepatitis A is usually self-limited, yet a minority develop prolonged cholestasis with severe jaundice and pruritus that prolong hospitalization and impair quality of life. Evidence for systemic corticosteroids remains limited. We report a steroid-responsive case. A previously healthy 30-year-old Korean woman presented with seven days of fever and malaise and was diagnosed with acute hepatitis A. Despite supportive care, marked cholestasis persisted while aminotransferases stabilized. Imaging examinations excluded bile duct obstruction and autoimmune serologies were negative. On hospital day 25, prednisolone 1 mg/kg was commenced, and following corticosteroid initiation, pruritus and jaundice improved within days, with a progressive decline in bilirubin, and the dose was tapered without biochemical rebound. Systemic corticosteroids may constitute an effective short-term therapeutic option for prolonged cholestasis secondary to acute hepatitis A after exclusion of alternative etiologies and with appropriate infection risk assessment.