was detected and genotyped. In immunohistochemical staining of liver biopsy specimens, HAV antigens showed strongly positive staining, in contrast to no staining for HEV antigens, although we were not able to obtain adequate positive control specimens. All of these results suggested the false positive reaction of initially positive IgM anti-HEV, rather than a true coinfection of HEV along with HAV.12 Severe cell necrosis associated with HAV infection may induce autoimmune reaction such as hemolytic anemia or autoimmune hepatitis.13,14 Nonspecific induction of IgM anti-HEV during massive hepatic necrosis death in the hepatitis phase of this case may be a possibility. In conclusion, severe autoimmune hemolytic anemia and prolonged cholestasis can be complicated with acute hepatitis co-infected by HAV genotype IA and IIIA, which was successfully treated with high-dose prednisolone therapy. The coexistence of IgM anti-HEV in the setting of hepatitis A seems to be a false positive reaction rather than a true coinfection. REFERENCES 1. Song KS, Kim MJ, Jang CS, Jung HS, Lee HH, Kwon OS, et al. Clinical features of acute viral hepatitis A complicated with acute renal failure. Korean J Hepatol 2007;13:166-173. 2. Schiff ER. Atypical clinical manifestations of hepatitis A. Vaccine 1992;10(Suppl 1):S18-S20. 3. Nainan OV, Xia G, Vaughan G, Margolis HS. Diagnosis of hepatitis a virus infection: a molecular approach. Clin Microbiol Rev 2006;19: Hee-Sup Kim, et al. Coinfection hepatitis A genotype IA and IIIA 327 63-79. 4. Yun H, Kim S, Lee H, Byun KS, Kwon SY, Yim HJ, et al. Genetic analysis of HAV strains isolated from patients with acute hepatitis in Korea, 2005-2006. J Med Virol 2008;80:777-784. 5. Lin CC, Wu JC, Chang TT, Chang WY, Yu ML, Tam AW, et al. Diagnostic value of immunoglobulin G (IgG) and IgM anti-hepatitis E virus (HEV) tests based on HEV RNA in an area where hepatitis E is not endemic. J Clin Microbiol 2000;38:3915-3918. 6. Mizuo H, Suzuki K, Takikawa Y, Sugai Y, Tokita H, Akahane Y, et al. Polyphyletic strains of hepatitis E virus are responsible for sporadic cases of acute hepatitis in Japan. J Clin Microbiol 2002;40:3209-3218. 7. Chehal A, Sharara AI, Haidar HA, Haidar J, Bazarbachi A. Acute viral hepatitis A and parvovirus B19 infections complicated by pure red cell aplasia and autoimmune hemolytic anemia. J Hepatol 2002;37:163-165. 8. Byun KS, Kim JH, Song KJ, Baek LJ, Song JW, Park SH, et al. Molecular epidemiology of hepatitis A virus in Korea. J Gastroenterol Hepatol 2001;16:519-524. 9. Coppola N, Genovese D, Pisaturo M, Taffon S, Argentini C, Pasquale G, et al. Acute hepatitis with severe cholestasis and prolonged clinical course due to hepatitis A virus Ia and Ib coinfection. Clin Infect Dis 2007;44:e73-e77. 10. Zaki Mel S, Salama OS, Mansour FA, Hossein S. Hepatitis E virus coinfection with hepatotropic viruses in Egyptian children. J Microbiol Immunol Infect 2008;41:254-258. 11. Kang HM, Jeong SH, Kim JW, Lee D, Choi CK, Park YS, et al. Recent etiology and clinical features of acute viral hepatitis in a single center of Korea. Korean J Hepatol 2007;13:495-502. 12. Mast EE, Kuramoto IK, Favorov MO, Schoening VR, Burkholder BT, Shapiro CN, et al. Prevalence of and risk factors for antibody to hepatitis E virus seroreactivity among blood donors in Northern California. J Infect Dis 1997;176:34-40. 13. Vento S, Garofano T, Di Perri G, Dolci L, Concia E, Bassetti D. Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals. Lancet 1991;337:1183-1187. 14. Huppertz HI, Treichel U, Gassel AM, Jeschke R, Meyer zum Büschenfelde KH. Autoimmune hepatitis following hepatitis A virus infection. J Hepatol 1995;23:204-208.