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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.<\/jats:p>","DOI":"10.1177\/00494755251389746","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T15:56:12Z","timestamp":1761666972000},"page":"128-130","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rare but real: Unusual manifestations of hepatitis A"],"prefix":"10.1177","volume":"56","author":[{"given":"Shubham","family":"Bansal","sequence":"first","affiliation":[{"name":"Maulana Azad Medical College and Lok Nayak Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5847-8312","authenticated-orcid":false,"given":"Akanksha","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Maulana Azad Medical College and associated Lok Nayak Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6922-6548","authenticated-orcid":false,"given":"Mukta","family":"Mantan","sequence":"additional","affiliation":[{"name":"Maulana Azad Medical College and Lok Nayak Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"1","article-title":"Prevention of hepatitis A through active or passive immunization: ACIP recommendations","volume":"55","author":"Fiore AE","year":"2006","unstructured":"Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: ACIP recommendations. MMWR Recomm Rep 2006; 55: 1\u201323.","journal-title":"MMWR Recomm Rep"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s43054-022-00132-z"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/3625139"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.32677\/IJCH.2020.v07.i12.008"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1515\/med-2024-0905"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0377-1237(17)30870-5"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01076525"},{"key":"e_1_3_2_9_2","first-page":"172","article-title":"Acute pancreatitis in hepatitis A infection in a 10-year-old boy","volume":"5","author":"Rana SK","year":"2013","unstructured":"Rana SK, Singh R, Aggarwal B, et al. Acute pancreatitis in hepatitis A infection in a 10-year-old boy. Pediatr Infect Dis 2013 Oct 1; 5: 172\u2013174.","journal-title":"Pediatr Infect Dis"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.i43.5741"}],"container-title":["Tropical Doctor"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00494755251389746","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00494755251389746","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00494755251389746","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:37:46Z","timestamp":1777642666000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00494755251389746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/00494755251389746"],"URL":"https:\/\/doi.org\/10.1177\/00494755251389746","relation":{},"ISSN":["0049-4755","1758-1133"],"issn-type":[{"value":"0049-4755","type":"print"},{"value":"1758-1133","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]}}}