Acute hepatitis A and E virus dual infection in a beta thalassemia major child complicated with hypocalcemia and secondary hyperparathyroidism: A case report

Abstract

Hepatitis A (HAV) and E (HEV) dual infection, though rare and self-limiting, can lead to acute liver failure, particularly in high-risk patients such as those with beta-thalassemia major. This case report presents a 16-year-old male with beta-thalassemia major and no prior liver disease who presented to the outpatient department with a week's history of low-grade fever, jaundice, and dyspnea. Upon thorough investigation, dual-infection with hepatitis A and hepatitis E virus was found complicated by hypocalcemia (Ca = 4 mg/dl) and secondary hyperparathyroidism (PTH = 80 pg/dl). The diagnosis was confirmed through serology and laboratory findings, including elevated liver enzymes, low serum calcium, and high parathyroid hormone levels. He received aggressive supportive management, including intravenous hydration, syrup Hepa Merz (L-Ornithine, L-Aspartate) twice daily for seven days, folic acid supplementation for beta thalassemia, paracetamol for symptom relief, and intravenous calcium twice infusion over the span of seven days, leading to full recovery and discharge on oral calcium supplements. This case highlights the potential severity of HAV/HEV dual infection in thalassemia patients, emphasizing the need for prompt diagnosis, electrolyte monitoring, and aggressive supportive care. Additionally, it underscores the importance of preventive strategies, including HAV vaccination, improved hygiene, safe water and food practices and awareness and education. The report contributes to the limited literature on metabolic complications (hypocalcemia, secondary hyperparathyroidism) in such dual infections and reinforces the necessity of early intervention in high-risk populations. It also highlights the necessity of more research on the complications of dual infection with HAV and HEV in a beta-thalassemia major patient.