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A history lesson: hepatitis is not always what it seems.

Two unusual hepatic presentations of otherwise common infectious diseases are reported in this issue ofThe Journal(pp 1999 and 2000). They illustrate that while viral A, B, and non-A, non-B acute hepatitis are ubiquitous, there are other infectious agents associated with hepatitis. The clinician must therefore consider other diagnostic possibilities among different age groups. In the neonate, cytomegalic inclusion-virus is a major cause of fetal and infant morbidity, followed by rubella (congenital or acquired) and herpes simplex (type 2 more than type 1). 1 Hepatitis seen with these viral illnesses is usually associated with other physical findings that may aid in their diagnosis. The presence of associated heart disease, pneumonitis, retinopathy, bleeding diathesis, or skin changes may be important clues to the nature of the viral illness. When acute hepatitis alone is present in the neonate, and viral isolation and serological findings are negative, metabolic or hereditary causes should