Articular and cutaneous prodromal manifestations of viral hepatitis.
The association of arthritis, arthralgia, and various types of skin rashes, as a prodrome to viral hepatitis, although well recognized in adults, has not been well described in children. In an 18-month period, three children presented with this serum sickness-like illness before the onset of evident liver involvement. In one case, the prodromal symptoms occurred four weeks before biochemical or clinical evidence of hepatitis. The SSLI tended to subside with the onset of clinically evident liver disease. Hepatitis B surface antigen (HBsAg, Australia antigen) was detected in the sera of two patients, but free antibody to the antigen was not demonstrable in either one. Serum complement levels were low during the prodromal phase and tended to return to normal value at the onset of extensive liver involvement. The diagnosis of viral hepatitis should be considered in children presenting with polyarthritis, polyarthralgia, and a rash (serum sickness-like illness) of uncertain etiology.