{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:23:41Z","timestamp":1787801021280,"version":"build-2784847793"},"reference-count":12,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,8,31]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>Hepatitis A is one of the most common causes of acute viral hepatitis in children. Immunological manifestations involving the nervous system are rare with hepatitis A infection. We report a case of a toddler who presented with acute liver failure secondary to hepatitis A infection. The child showed clinical and laboratory improvement initially with conservative management. However, after the initial improvement, she developed acute-onset ptosis along with areflexia. Serological and neurophysiological tests revealed the occurrence of ocular variant Guillain-Barr\u00e9 syndrome and ocular myasthenia gravis, which was only partially responsive to treatment (intravenous immunoglobulin and pyridostigmine). A sudden clinical deterioration was noted after the onset of ptosis. She succumbed on day 40 of hospitalisation due to hospital-acquired infection along with the primary hepatic pathology. This is a rare coincidental presentation of acute viral hepatitis A infection with autoimmune manifestations.<\/jats:p>","DOI":"10.1136\/bcr-2023-254855","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T13:00:53Z","timestamp":1696856453000},"page":"e254855","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Acute liver failure due to hepatitis A virus presented with Guillain-Barr\u00e9 syndrome and ocular myasthenia gravis"],"prefix":"10.1136","volume":"16","author":[{"given":"Aswanth","family":"KS","sequence":"first","affiliation":[{"name":"Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod","family":"Kumar","sequence":"additional","affiliation":[{"name":"Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhil Raj","family":"MS","sequence":"additional","affiliation":[{"name":"Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nowneet Kumar","family":"Bhat","sequence":"additional","affiliation":[{"name":"Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"2025082702282314000_16.10.e254855.1","unstructured":"Zuckerman AJ . 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