Janczura J, Brzdęk M, Brzdęk K, Lewitowicz P, Zbylut N, Zarębska-Michaluk D, Stępień PM, Dobrowolska K. Hepatitis A virus-induced autoimmune hepatitis: A case-based review. World J Hepatol 2026; 18(5): 117837 [DOI: 10.4254/wjh.v18.i5.117837]
Corresponding Author of This Article
Dorota Zarębska-Michaluk, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Radiowa 7, Kielce 25-516, Poland. dorota1010@tlen.pl
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. May 27, 2026; 18(5): 117837 Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.117837
Hepatitis A virus-induced autoimmune hepatitis: A case-based review
Jakub Janczura, Michał Brzdęk, Kinga Brzdęk, Piotr Lewitowicz, Nina Zbylut, Dorota Zarębska-Michaluk, Piotr M Stępień, Krystyna Dobrowolska
Jakub Janczura, Michał Brzdęk, Collegium Medicum, Jan Kochanowski University, Kielce 25-516, Poland
Michał Brzdęk, Department of Gastroenterology, Medical University of Lodz, Lodz 92-213, Poland
Kinga Brzdęk, Department of Rheumatology and Connective Tissue Diseases, Nicolaus Copernicus Memorial Hospital, Lodz 93-513, Poland
Piotr Lewitowicz, Nina Zbylut, Krystyna Dobrowolska, Department of Clinical and Experimental Pathology, Institute of Medical Sciences, Jan Kochanowski University, Kielce 25-317, Poland
Dorota Zarębska-Michaluk, Piotr M Stępień, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Kielce 25-516, Poland
Author contributions: Janczura J, Brzdęk M, Brzdęk K, Zarębska-Michaluk D, and Dobrowolska K contributed to the writing and editing of the manuscript; Janczura J, Zarębska-Michaluk D, and Dobrowolska K additionally responsible for the study concept and literature review; Janczura J further undertaking graphic design; Lewitowicz P and Zbylut N performed the histopathological description of liver biopsy specimens and prepared the images; Stępień PM contributed to the editing of the manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: The author only used Grammarly to edit the text, solely for language polishing. This manuscript was not generated by an AI. No part of the manuscript was created by an AI (abstract, materials and methods, results, discussion, conclusion). No AI was used for data analysis, research design, or data interpretation. No images were generated by AI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Dorota Zarębska-Michaluk, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Radiowa 7, Kielce 25-516, Poland. dorota1010@tlen.pl
Received: December 17, 2025 Revised: January 4, 2026 Accepted: February 24, 2026 Published online: May 27, 2026 Processing time: 160 Days and 12.6 Hours
Abstract
Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disease of complex and multifactorial origin, arising from the interplay of genetic susceptibility and environmental triggers. Among infectious factors, hepatitis A virus (HAV) infection has emerged as a potential precipitant of autoimmune responses leading to AIH onset. This mini-review explores the current understanding of HAV-induced AIH, summarizing available literature on its epidemiology, proposed immunopathogenic mechanisms, and diagnostic challenges. Special attention is given to the overlap between acute viral hepatitis and autoimmune activation, as well as the clinical and histological features that may distinguish secondary autoimmune phenomena from de novo AIH. The review is complemented by clinical experience drawn from a recently observed case of HAV-triggered AIH in a young adult, which illustrates the diagnostic complexity and therapeutic responsiveness of such presentations. Management strategies, including corticosteroid-based immunosuppression and long-term monitoring, are also discussed in the context of recent evidence and international guidelines. Recognizing HAV as a potential trigger of AIH is essential for timely diagnosis, optimal treatment selection, and prevention of disease progression in affected patients.
Core Tip: This article explores the emerging link between acute hepatitis A virus infection and the onset of autoimmune hepatitis, integrating current evidence with clinical experience. It highlights the immunopathogenic mechanisms potentially responsible for hepatitis A virus-triggered autoimmunity and discusses diagnostic and therapeutic challenges in distinguishing post-viral hepatitis from de novo autoimmune hepatitis. Emphasizing the importance of early recognition and guideline-based management, the review underscores how awareness of this rare but significant association can improve diagnostic accuracy and patient outcomes.
