Abstract / Summary
Taher A Alhaddad,1 Ahmed Alsaffar,1 Bashair Alnemer,1 Lojain Alsahman II,2 Reda Aleid,2 Shahab Ahmed Alsuliman Snr31Department of Internal Medicine, Dammam Medical Complex, Dammam, Saudi Arabia; 2Department of Hematology, Dammam Medical Complex, Dammam, Saudi Arabia; 3Department of Infectious Diseases, Dammam Medical Complex, Dammam, Saudi ArabiaCorrespondence: Bashair Alnemer, Department of Internal Medicine, Dammam Medical Complex, Dammam, Saudi Arabia, Email Bashair.alnemer@gmail.comBackground: Hepatitis‑associated aplastic anemia (HAAA) is a rare but life‑threatening immune‑mediated complication of acute viral hepatitis, and hepatitis A virus is an uncommon cause of this syndrome.Case Presentation: We report the case of a 24‑year‑old woman who developed acute hepatitis A followed by rapidly progressive pancytopenia fulfilling the criteria for very severe aplastic anemia. Her clinical course was complicated by febrile neutropenia, transfusion dependence, gastrointestinal bleeding, and Stenotrophomonas maltophilia bacteremia. Bone marrow biopsy demonstrated marked hypocellularity with severe trilineage suppression. Despite intensive supportive care including broad-spectrum antimicrobial therapy and transfusion support, her clinical condition deteriorated, and she died from infectious and hemorrhagic complications before definitive therapy could be initiated. This case emphasizes the importance of early recognition of cytopenias during the acute phase of hepatitis and prompt hematology referral for definitive management.Conclusion: Aplastic anemia following acute hepatitis A infection is rare but potentially fatal. Early recognition of cytopenias during or following acute hepatitis, prompt bone marrow evaluation, and urgent hematology referral is essential for timely definitive treatment and improved outcomes.Keywords: hepatitis-associated aplastic anemia, hepatitis A virus, pancytopenia, bone marrow failure, very severe aplastic anemia