Prolonged Cholestatic Hepatitis A in an Unvaccinated International Traveler

Hepatitis A is a viral infection that is generally self-limited, although atypical, prolonged forms and fatal outcomes may occur. This case report describes a 33-year-old Brazilian man, previously healthy and unvaccinated, who developed prolonged cholestatic hepatitis A acquired during international travel. He had traveled through areas with precarious sanitation and consumed untreated water in a rural region of Zambia, Africa. Initial symptoms were nonspecific and progressed to jaundice, dark urine, and acholic stools. The diagnosis of acute hepatitis A was confirmed serologically, with markedly elevated transaminases and predominantly direct hyperbilirubinemia. Despite initial clinical improvement, he persisted with jaundice and diarrhea for more than two months, with continued fecal shedding of hepatitis A virus (HAV) RNA. Treatment included symptomatic medications and ursodeoxycholic acid due to cholestasis, with good clinical resolution after four months. This report aims to highlight the prolonged course of hepatitis A in adults, distinct from the typically faster resolution observed in children, and to reinforce the importance of vaccination among the general population and in travel medicine counseling, especially for adults from countries with low endemicity for hepatitis A.