{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:24:49Z","timestamp":1791347089641,"version":"4.3.1"},"reference-count":11,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,13]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:p>Hepatitis A virus (HAV) infection typically presents as a self-limiting illness but it can cause debilitating symptoms and rarely fulminant hepatitis (acute liver failure), which is often fatal. WHO estimates that in 2016, 7134 persons died from hepatitis A worldwide (accounting for 0.5% of the mortality due to viral hepatitis). Fulminant hepatic failure is observed in less than 1% of cases of acute viral hepatitis A. Haemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome of excessive inflammation and tissue destruction owing to abnormal immune activation. Acquired HLH due to viral infections (also known as virus-associated haemophagocytic syndrome) is most commonly associated with Epstein-Barr virus and cytomegalovirus (CMV). HAV-associated HLH has been rarely reported. Haemolysis of mild to moderate degree is not unheard of in cases of hepatitis A, which is often immune-mediated. Here, we present the case of a man in his 30s, with G6PD deficiency unmasked by acute viral hepatitis A, which later on progressed to hyperacute liver failure, HLH and renal failure.<\/jats:p>","DOI":"10.1136\/bcr-2024-260785","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T01:01:32Z","timestamp":1725411692000},"page":"e260785","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Acute hepatitis A with haemophagocytic lymphohistiocytosis: G-6PD deficiency-induced haemolytic anaemia and bile cast nephropathy"],"prefix":"10.1136","volume":"17","author":[{"given":"Biju","family":"Illolil Kuniyil","sequence":"first","affiliation":[{"name":"Gastroenterology, Baby Memorial Hospital, Kozhikode, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer Sakkeer","family":"Hussain","sequence":"additional","affiliation":[{"name":"Medical Gastroenterology, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gouri","family":"Suresh","sequence":"additional","affiliation":[{"name":"Medical Gastroenterology, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semeera","family":"Thoufeeq","sequence":"additional","affiliation":[{"name":"Internal Medicine, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"2025082710335371000_17.9.e260785.1","doi-asserted-by":"crossref","first-page":"6653","DOI":"10.1016\/j.vaccine.2010.08.037","article-title":"Hepatitis A virus seroprevalence by age and world region, 1990 and 2005","volume":"28","author":"Jacobsen","year":"2010","journal-title":"Vaccine (Auckl)"},{"key":"2025082710335371000_17.9.e260785.2","article-title":"Hemophagocytic Lymphohistiocytosis and 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obstructive jaundice: a prospective study","volume":"22","author":"Uslu","year":"2010","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2025082710335371000_17.9.e260785.10","doi-asserted-by":"publisher","DOI":"10.4103\/ijccm.IJCCM_260_18"},{"key":"2025082710335371000_17.9.e260785.11","first-page":"5512883","article-title":"Acute Hepatitis A Causing Severe Hemolysis and Renal Failure in Undiagnosed Glucose-6-Phosphate Dehydrogenase Deficient Patient: A Case Report and Review of the Literature","volume":"2021","author":"Abutineh","year":"2021","journal-title":"Case Rep Hepatol"}],"container-title":["BMJ Case 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