Cholestatic Hepatitis In some patients, most commonly during HAV infection, a self-limited period of cholestatic jaun-dice may supervene that is characterized by marked coniugated hyperbilirubinemia, elevation of alkaline phosphatase, and pruritus. Investigation may be required to differentiate this condition from mechanical obstruction of the biliary tree.

Fulminant Hepatitis Massive hepatic necrosis occurs in < 1% of patients with acute viral hepatitis and leads to a dev-astating and often fatal condition called fulminant hepatic fail-ure.

Chronic Hepatitis Hepatitis A does not progress to chronic liver disease, although occasionally it has a relapsing course. Persistence of transaminase elevation beyond 6 months in patients with hepatitis B and C suggests evolution to chronic hepatitis, although slowly resolving acute hepatitis may occa-sionally lead to abnormal liver funcation tests for up to 12 months, with eventual complete resolution. HBV infection without evidence of any liver damage may persist, resulting in asymptomatic or "healthy" hepatitis B carriers. In Asia and Africa, many such carriers appear to have acquired the virus from infected mothers during infancy.

Rare Complication Acute viral hepatitis may be fol-lowed by aplastic anemia, which affects mostly male patients and results in a mortality of greater than 80%. Pancreatitis, myocarditis, and neurologic complications including Guillain-Barre syndrome, aseptic meningitis, and encephalitis have also been reported. Cryoglobulinemia, glomerulonephritis, and polyarteritis nodosa are associated with hepatitis B.

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