Bi-phasic hepatitis A

Hepatitis A virus infection is the most probable diagnosis to a child with elevated serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with elevated total billrubin especially in the developing countries. A positive Anti Hepatitis A IgM (Anti HAV IgM) usually will confirm the diagnosis. Knowing that most cases of Hepatitis A is self limited and chronicity is not recognised3, relapse or poly-phasic course can present a clinical difficulty to paediatrician and can lead to a lot of unnecessary and costly investigations. The following case report represents this condition.