{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:04:27Z","timestamp":1784307867785,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hepatitis A virus (HAV) and hepatitis E virus (HEV) are common causes of acute viral hepatitis in developing countries where inadequate sanitation and contaminated water supplies facilitate fecal\u2013oral transmission. Although both infections are usually self\u2010limiting, co\u2010infection may result in atypical presentations and pose diagnostic challenges. We report the case of a previously healthy 14\u2010year\u2010old girl who presented with a 5\u2010day history of nausea, vomiting, and anorexia, followed by sudden\u2010onset jaundice and dark urine. She denied fever, abdominal pain, pruritus, bleeding manifestations, or altered mental status. Physical examination revealed marked icterus without hepatosplenomegaly or stigmata of chronic liver disease. Laboratory investigations demonstrated significant hyperbilirubinemia and elevated liver transaminases. Serological testing confirmed acute HAV and HEV co\u2010infection with positive anti\u2010HAV IgM and anti\u2010HEV IgM antibodies. Abdominal ultrasonography showed a normal\u2010sized liver with altered echogenicity and a characteristic \u201cstarry sky\u201d appearance, along with gallbladder wall thickening without calculi or sludge. The patient received supportive treatment, including intravenous fluids, antiemetics, and symptomatic care. Her clinical condition improved steadily, with resolution of symptoms and progressive normalization of liver function tests during hospitalization. She was discharged in stable condition and remained asymptomatic at 14\u2010day follow\u2010up, with complete biochemical and radiological recovery. This case highlights that HAV\u2013HEV co\u2010infection can present with isolated jaundice and minimal systemic symptoms despite significant hepatic involvement. Recognition of characteristic imaging findings and timely serological evaluation can facilitate early diagnosis. Favorable outcomes can be achieved with supportive management, while prevention through vaccination, safe drinking water, and improved hygiene remains essential in endemic regions.<\/jats:p>","DOI":"10.1002\/ccr3.72857","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:41:47Z","timestamp":1780461707000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Co\u2010infection of Hepatitis A and E With Atypical Manifestation: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0802-476X","authenticated-orcid":false,"given":"Umaimah","family":"Batool Mirza","sequence":"first","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4035-5081","authenticated-orcid":false,"given":"Habib Ul Rahman","family":"Kalhoro","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7862-5515","authenticated-orcid":false,"given":"FNU","family":"Umna","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2930-8188","authenticated-orcid":false,"given":"Ahmed Asad","family":"Raza","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8614-3924","authenticated-orcid":false,"given":"Abedin","family":"Samadi","sequence":"additional","affiliation":[{"name":"Kabul University of Medical Sciences  Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10018-1172"},{"issue":"1","key":"e_1_2_14_3_1","article-title":"Hepatitis A: Viral Structure, Classification, Life Cycle, Clinical Symptoms, Diagnosis Error, and Vaccination","volume":"2023","author":"Gholizadeh O.","year":"2023","journal-title":"Canadian Journal of Infectious Diseases and Medical Microbiology = Journal Canadien Des Maladies Infectieuses et De La Microbiologie Medicale"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.5501\/wjv.v13.i2.91580"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1213566"},{"issue":"2","key":"e_1_2_14_6_1","first-page":"86","article-title":"Changing Trend of Viral Hepatitis\u2014\u2018A Twenty One Year Report From Pakistan Medical Research Council Research Centre, Jinnah Postgraduate 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