hepatitis a virus ( hav ) occurs throughout the world , and humans are thought to be its principal host . type-1 diabetes is a disorder of glucose metabolism that results from insulin deficiency secondary to autoimmune destruction of insulin - secreting -cells . although the pathogenesis of type-1 diabetes is unknown , human leukocyte antigen typing , viral infections and t - cell autoimmunity may be involved . the prevalence of liver disease among diabetics is estimated to be between 17 and 100% . the present paper describes a 9- year - old girl who has type-1 diabetes and presented hav infection . she describes vomiting is non - bilious , non - bloody and it is food content . it is associated with generalized mild abdominal pain with no relieving or precipitating factors . physical examination revealed yellowish discoloration of eyes and skin but no evidence of growth retardation . abdominal ultrasound showed multiple hyper echoic foci with mild ascites , gallbladder wall was thickened with pericholecystic fluids . a diagnosis of acute hav infection was made and the child was managed with diabetes protocol . at 3 months follow up from the onset of disease , she was completely asymptomatic , hepatitis a immunoglobulin m became negative and other laboratory investigations normalized . patients with type-1 diabetes are predisposed to develop a spectrum of liver diseases which includes fatty liver , steatohepatitis , cirrhosis , hepatic failure and hepatocellular carcinoma . the association of hav infection with type-1 diabetes have been described in adult . to the best of our knowledge , our case is the first case report in a children . although the pathogenesis of type-1 diabetes is unknown , viral infections may or may not be involved . kondrashova and colleagues , demonstrated a possible protective effect of microbes in animal models , where hav has associated with low risk of type-1 diabetes . another study showed that hepatitis virus infection ( hav , hbv , hcv and hev ) were not associated with type-1 diabetes . in contrast , patients with diabetes are at risk to contact viral hepatitis infection . singh and colleagues documented that patients with diabetes mellitus are at high risk to develop severe hepatitis as well as liver failure subsequent to acute viral infection mainly hepatitis b virus but hav was not involved . makken and colleagues showed that three patients with diabetic ketoacidosis have been reported within 2 - 3 weeks of acute hepatitis a , although the c - peptide levels were not measured . hwang and colleagues reported an adult man who presented with fulminant type-1 diabetes and acute hav . we believe that the immune system in the child may play a role in good prognosis of diabetes and hav . ertem and colleagues reported hav is associated with immune - associated diseases , including autoimmune hepatitis , immune thrombocytopenic purpura , cryoglobulinaemia and vasculitis . the data of ertem and colleagues taken together with the observation in our patient suggest that hav is associated with immune - associated diseases such as type-1 diabetes . we found that hav could be associated with immune - associated diseases such as type-1 diabetes . however , the mechanism of hepatitis a virus - induced b - cell destruction is unknown . this case report emphasizes the need for more research to help in understanding the association of type-1 diabetes with hav infection .
patients with type-1 diabetes are predisposed to develop a spectrum of liver diseases , which includes fatty liver , steatohepatitis and cirrhosis . 
 the association of hepatitis a infection with type-1 diabetes is extremely rare . to the best of our knowledge , 
 our case is the first case report in children . 
 we described a nine year - old girl who had type-1 diabetes and developed hepatitis a virus infection without complications . 
 a review of the literature is also provided .