Hepatitis A Virus-associated Cholecystitis

Cholestatic hepatitis [1] and cholecystitis [2, 3] are poorly recognized manifestations of acute hepatitis A virus (HAV) infection. Although previous studies showed that HAV-associated RNA and antigen are present predominantly in hepatocytes and, to a lesser extent, in Kupffer cells, the pathogenesis of these abnormalities remains unknown [4]. To understand better the mechanisms of HAV-associated cholestasis and cholecystitis, we did an immunohistochemical analysis of liver and gallbladder specimens from an elderly patient with cholestatic hepatitis A and acalculous cholecystitis. A microscopic examination revealed portal inflammation and pericholangitis as well as cholestasis in the liver and lymphocytic cholecystitis. In contrast to weak staining in approximately 30% of hepatocytes, intense cytoplasmic staining of HAV antigen was detected in the epithelium of both the intrahepatic bile ducts and the gallbladder. These findings suggest that HAV can directly infect biliary epithelium and that such an infection may have an important role in the pathogenesis of cholestasis and gallbladder …