Isolated Bilateral Pleural Effusion in Acute Hepatitis A Infection: A Rare Pediatric Presentation

Background: Hepatitis A virus (HAV) infection remains a significant cause of acute viral hepatitis among children in developing regions. Although the illness is predominantly self-limiting and primarily affects the liver, atypical systemic manifestations have occasionally been reported. Pleural effusion is an exceptionally rare complication and is generally described in conjunction with ascites. Case Presentation: We report the case of a four-year-old female with serologically confirmed acute HAV infection who developed bilateral pleural effusion in the absence of ascites. The child presented with prolonged fever followed by jaundice, vomiting, abdominal pain, dark urine, and progressive respiratory difficulty. Laboratory findings demonstrated conjugated hyperbilirubinemia and markedly elevated transaminases. Anti-HAV IgM antibodies confirmed acute infection. Radiological evaluation revealed bilateral pleural effusion without intra-abdominal fluid accumulation. Pleural fluid examination was consistent with a transudative effusion, and microbiological studies were negative. The patient improved with supportive management and showed complete clinical and biochemical recovery. Conclusion: Pleural effusion represents a rare and typically benign extrahepatic manifestation of acute HAV infection, even in the absence of ascites. Awareness of this self-limiting complication is essential to prevent unnecessary diagnostic procedures and overtreatment.