{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:48:19Z","timestamp":1775818099282,"version":"3.50.1"},"reference-count":14,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children. Severe complications are rare but may occur, particularly in older children or in the presence of concomitant conditions. Case Presentation: We report the case of an 11-year-old girl with acute hepatitis A with severe hepatic derangements who developed life-threatening upper gastrointestinal bleeding due to a previously undiagnosed duodenal ulcer. Emergency endoscopy confirmed active bleeding from a duodenal ulcer, and the patient survived the complications with treatment with a proton pump inhibitor and hemostatic management with blood products. Conclusions: Although hepatitis A is generally benign in children, this case highlights the potential for severe and life-threatening complications.<\/jats:p>","DOI":"10.3390\/children13040526","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:08:12Z","timestamp":1775812092000},"page":"526","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Life-Threatening Gastrointestinal Bleeding in a Child with Acute Hepatitis A"],"prefix":"10.3390","volume":"13","author":[{"given":"Simona","family":"Zlatanova","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, Blvd Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria"},{"name":"Clinic of Infectious Diseases and Parasitology, St. George\u2019s University Hospital, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5275-7799","authenticated-orcid":false,"given":"Meri","family":"Hristamyan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5395-9125","authenticated-orcid":false,"given":"Kostadin","family":"Ketev","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St. George\u2019s University Hospital, 4002 Plovdiv, Bulgaria"},{"name":"Medical Simulation Training Center, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","unstructured":"Girish, V., Grant, L.M., and John, S. (2026, January 15). Hepatitis A, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459290\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e14030","DOI":"10.1111\/jvh.14030","article-title":"Evolution and impact of hepatitis A epidemiology in Europe: Systematic literature review of the last 20 years","volume":"32","author":"Andani","year":"2025","journal-title":"J. Viral Hepat."},{"key":"ref_3","first-page":"1000139","article-title":"Prevalence of hepatitis A virus in Bulgaria","volume":"4","author":"Kevorkian","year":"2015","journal-title":"J. Virol. Antivir. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"145","DOI":"10.3897\/jbcr.e147733","article-title":"Incidence of infectious diseases in Bulgaria and Pleven region for a 20-year period (2004\u20132023)","volume":"18","author":"Gancheva","year":"2025","journal-title":"J. Biomed. Clin. Res."},{"key":"ref_5","unstructured":"European Centre for Disease Prevention and Control (2026, January 15). Hepatitis A Country Profile: Bulgaria. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/media\/en\/healthtopics\/hepatitis_A\/Documents\/hepatitis-a-eu-eea-country-profile-bulgaria.pdf."},{"key":"ref_6","first-page":"e28290","article-title":"The clinical profile of children with hepatitis A infection: An observational hospital-based study","volume":"14","author":"Murlidharan","year":"2022","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/jpn3.70083","article-title":"Severe hepatitis in pediatric patients: The Severe Hepatitis In Pediatric Patients (SHIPP) registry","volume":"81","author":"Kehar","year":"2025","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Rodriguez-Frias, F., Rando-Segura, A., and Quer, J. (2023). Solving the enigma of pediatric severe acute hepatitis of unknown origin. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1175996"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1007\/s12072-021-10232-4","article-title":"Global trends and regional differences in incidence and mortality of hepatitis A from 1990 to 2019","volume":"15","author":"Cao","year":"2021","journal-title":"Hepatol. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s12098-013-1114-8","article-title":"Hepatitis A in children: Clinical course, complications and laboratory profile","volume":"81","author":"Kumar","year":"2014","journal-title":"Indian J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"542","DOI":"10.18203\/2349-3291.ijcp20250755","article-title":"Clinical profile of hepatitis A virus infection in children in a tertiary care hospital","volume":"12","author":"Baidya","year":"2025","journal-title":"Int. J. Contemp. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Migueres, M., Lhomme, S., and Izopet, J. (2021). Hepatitis A: Epidemiology, high-risk groups, prevention and research on antiviral treatment. Viruses, 13.","DOI":"10.3390\/v13101900"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1097\/MS9.0000000000003107","article-title":"Acute hepatitis A-associated aplastic anemia in a pediatric patient: A case report","volume":"87","author":"Albostani","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_14","first-page":"419","article-title":"Massive gastrointestinal bleeding masquerading coagulopathy in acute viral hepatitis: A case report","volume":"58","author":"Pokhrel","year":"2020","journal-title":"JNMA J. Nepal Med. Assoc."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/526\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:48:28Z","timestamp":1775814508000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["children13040526"],"URL":"https:\/\/doi.org\/10.3390\/children13040526","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]}}}