一例原因不明之持續A型肝炎病毒IgM抗體陽性無症狀患者--個案報告

An Asymptomatic Patient with Persistent Anti-HAV IgM and Anti-HAV IgG: A Case Report and Literature Review

?一名61歲女性，因職業為供膳人員而需要每年健檢，2015年於本院健檢時意外發現A型肝炎病毒IgM抗體(anti-HAV IgM)呈現陽性反應，懷疑是急性A型肝炎感染，因而轉至胃腸肝膽科門診檢查。個案本身並無症狀，實驗室報告顯示並無異常。隔年健康檢查仍發現anti-HAV IgM呈現陽性，再次安排實驗室檢查及理學檢查，也無顯示任何異常，隨後入院接受肝臟切片病理檢驗，但報告亦無特異性表現，且個案於住院期間也無任何不適。本次入院前，個案在外院也檢查了A型肝炎病毒IgG抗體(anti-HAV IgG)，發現也呈現陽性反應，且後續追蹤直至2020年期間，個案的anti-HAV IgM及anti-HAV IgG皆持續呈現陽性反應。持續性anti-HAV IgM陽性並不常見，本文針對造成持續性anti-HAV IgM陽性的原因，進行文獻回顧，並分析此案例可能的原因及後續適當之處理程序。

 

A 61-year-old female restaurant caterer had received regular annual health examinations. In 2015, hepatitis A virus immunoglobulin M antibody (anti-HAV IgM) was detected, though she showed no symptom or sign of HAV infection. She was then transferred to the gastroenterology (GI) outpatient clinic where she underwent further laboratory tests that revealed no specific findings. Medical certificates were therefore issued and regular follow-ups arranged. However, reactive anti-HAV IgM persisted with reactive result of anti-HAV IgG in 2016, and laboratory tests again showed negative findings. She was accordingly admitted for liver biopsy. Nevertheless, the pathology report also revealed no sign or symptom of infection, and she did not report any symptoms of HAV infection. As a result, she was discharged for annual monitoring. During the period from 2017 to 2020, she had visited our family medicine outpatient clinic for regular follow-ups; anti-HAV IgM and anti-HAV IgG were followed and revealed reactive findings. Persistent anti-HAV IgM is rare in the literature, and concurrent persistent anti-HAV IgG is even more unusual. In this article, we present a rare case of the above condition while the literature of persistent anti-HAV IgM is also reviewed.