A Confounding Case of Acute Hepatitis A

Hepatitis A (HAV) is a picornavirus transmitted via fecal-oral route that disproportionately affects homeless persons, men who have sex with men, and individuals use intravenous drugs. Acute HAV typically presents nausea, vomiting, abdominal pain, fever. It most commonly self-limited but can progress to fulminant hepatic failure in less than 1% of cases. The following case unique presentation acute infection requiring diagnostic dexterity critical thinking.