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June 26, 1981

Intercurrent Hepatitis A in B Viral Hepatitis

JAMA. 1981;245(24):2495. doi:10.1001/jama.1981.03310490013010

To the Editor.—  Since the course of chronic active hepatitis includes spontaneous exacerbations and remissions, it may be difficult to recognize an intercurrent and unrelated hepatic illness. Specific serological testing for hepatitis A and B has allowed a clearer definition, as regards etiology, in recurrent episodes of acute hepatitis as well as in chronic hepatitis.1 This short comment concerns a patient with known hepatitis B surface antigen (HBsAg)-positive associated chronic hepatitis/cirrhosis in whom an intercurrent episode of hepatitis A developed that would not have been appreciated without serological testing.

Report of a Case.—  A 58-year-old male health care worker had development of an acute HBsAg-positive viral hepatitis in March 1979. His liver function test results improved, but neither the alkaline phosphatase nor transaminase (SGOT) returned to normal levels over the following six months. Serological follow-up indicated that he continued to be HBsAg positive, anti-HBc positive, and anti-HBs negative. In