Cholestatic Viral Hepatitis

Cholestatic viral hepatitis is the least common clinical variant of viral hepatitis. The differentiation of this prolonged bile retention from extrahepatic cholestasis is clinically very important because of the totally different management. An unnecessary operation may adversely affect the good prognosis or even lead to death. In our 6 cases of cholestatic viral hepatitis, dark urine, jaundice, pale stool were seen in 6 cases, marked pruritus in 5 cases, mild fever and hepatomegaly in 3 cases. The serum bilirubin levels increased to very high level even to 54.4 mg/dl in 1 case, and alkaline phosphatase level increased also in all cases. According to hepatitis A and B markers, 2 cases were diagnosed as type A hepatitis, and 4 as non A, non B hepatitis. Endoscopic retrograde cholangiography demonstrated patent biliary tract, and peritoneoscopy showed greenish liver with some scars on the liver surface. The histopathology of the liver showed evident intrahepatic cholestasis in addition to acute viral hepatitis. The prognosis of this variant is very good, all the patients recovered completely with a clinical course of 2 to 4 months. Steroid therapy in our 2 cases didn't shorten the clinical course, so the benefit seems not justified in this disease.