Aim

The incidence of hepatitis A (HAV) in Iceland is low with about one case per year in the last decades. Since 2016, there has been an ongoing outbreak of HAV in men who have sex with men (MSM). The aim of this study was to inves­tigate whether cases diagnosed in Iceland during 2017 had any link to the HAV outbreak in Europe.

Methods

All cases of HAV in Iceland during 2017 were reviewed retrospectively.

Results

Four of five cases diagnosed during 2017 were MSM and one was a female. Three cases presented the same week in the summer 2017. The age of the patients was between 25 and 39 years. All the male patients had had sex with men from Europe and/or had travelled to Europe prior to admission. All cases had typical signs and symptoms of HAV infection and in all cases recent infection was confirmed by positive serology and exclusion of other causes of acute hepatitis. Four of five patients had radiological signs of changes in the gallbladder with thickening of the wall and oedema and one underwent later an elective cholecystectomy.

Conclusion

The outbreak of HAV in MSM Europe reached Iceland in the summer 2017, emphasizing the importance of vaccination in this risk group as recommended by the Icelandic Health Authorities. The review of these cases indicate that changes such as thickening of the gallbladder wall without gallstones in patients with HAV are common. It is important to discrimi­nate patients with these changes associated with HAV from patients with acute acalculus cholecystitis.

 

Figure 1. T2 weighted MRI showing constricted gallbladder with prominent oedema in the gallbladderwall. The appearance raised a suspicion of a rupture of the gallbladder.

Figure 2. Abdominal ultrasound showing a thickened but rather small gallbladder.

Figure 3. A CT scan showing small gallbladder with prominent oedema in the gallbladderwall.

Table I. Laboratory values for liver tests, INR, albumin and ferritin on admission. Reference values in brackets. *ALT: alanine aminotransferase, AST: aspartate aminotransferase, ALP: alkaline phosphatase, **INR for liver function.