Acute Liver Failure Associated with Hepatitis e Infection in a Young Man with Immune Thrombocytopenia (original) (raw)
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Hepatitis E Virus Infection as a Possible Cause of Acute Liver Failure in Europe
Clinical Gastroenterology and Hepatology, 2015
This article has an accompanying continuing medical education activity on page e158. Learning Objective-Upon completion of this activity, successful learners will be able to diagnose possible cases of hepatitis E virus associated liver failure. BACKGROUND & AIMS: In Western countries, infection with the hepatitis E virus (HEV) is considered to be rare and imported from endemic regions. However, the prevalence of HEV infection has increased among adults in central Europe. HEV infection can cause acute liver failure (ALF), but there have been only a few confirmed cases of HEV-associated ALF in Europe. We investigated the number of cases of indeterminate ALF associated with HEV infection. METHODS: We performed a retrospective analysis of 80 patients diagnosed with ALF or acute hepatitis at the University Hospital Essen in Germany from November 2006 through December 2013. Clinical data were collected from the hospital databases; archived sera were tested for IgG and IgM against HEV, as well as HEV RNA. RESULTS: Sera from 12 patients (15%) tested positive for IgG against HEV IgG; 7 of these samples did not test positive for HEV IgM or HEV RNA. Sera from 64 patients (80%) did not test positive for IgG or IgM against HEV or HEV RNA. Sera from 8 patients (10%) tested positive for HEV RNA (only 4 of these were positive for HEV IgG) and had clinical findings to support acute HEV infection. CONCLUSIONS: In a hospital in Germany, approximately 10% to 15% of patients with ALF had evidence for HEV infection. Serologic tests for IgG against HEV are insufficient to identify or exclude HEV infection; tests for HEV RNA also should be performed on patients with ALF of ambiguous etiology.
Hepatitis E Induced „Acute-On-Chronic” Liver Failure - Do We Transplant or Not?
Infektološki glasnik
Hepatitis E virus is a pathogen of worldwide significance. In developed countries, foodborne transmission of zoonotic genotypes is the most common route of infection. Transfusion transmitted infection is also an important source of infection, particularly in immunocompromised population. In most cases, HEV infection is asymptomatic or presents as an acute self-limiting hepatitis. Rarely it leads to fulminant hepatitis or „acute-on- chronic” liver failure in people with pre-existing chronic liver diseases. The aim of this report is to present the first documented case of HEV-related „acute-on-chronic” liver failure in Croatia in a patient with chronic liver disease listed for liver transplantation. Due to increasing incidence in industrialised countries, HEV infection should always be considered in the differential diagnosis of acute hepatitis and in patients with unexplained worsening of chronic liver disease.
The role of hepatitis E virus infection in Adult Americans with acute liver failure
Hepatology (Baltimore, Md.), 2016
Acute hepatitis E virus (HEV) infection is a leading cause of acute liver failure (ALF) in many developing countries yet rarely identified in Western countries. Since antibody testing for HEV infection is not routinely obtained, we hypothesized that HEV-related ALF might be present and unrecognized in North American ALF patients. Serum samples of 681 adults enrolled in the US ALF Study Group were tested for anti-HEV IgM and anti-HEV IgG levels. Subjects with a detectable anti-HEV IgM also underwent testing for HEV-RNA. Mean patient age was 41.8 years, 32.9% male, and ALF etiologies included acetaminophen hepatotoxicity (29%), indeterminate ALF (23%), idiosyncratic DILI (22%), acute HBV infection (12%), autoimmune hepatitis (12%) and pregnancy related ALF (2%). Three men ages 36, 39, and 70 demonstrated repeatedly detectable anti-HEV IgM but all were HEV RNA negative and had other putative diagnoses. The latter two subjects died within 3 and 11 days of enrollment while the 36 year ol...
Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients
Liver Transplantation, 2010
Hepatitis E virus (HEV) infection induces self-limiting liver disease in immunocompetent individuals. Cases of chronic hepatitis E have recently been identified in organ transplant recipients. We questioned if chronic hepatitis E plays a role in graft hepatitis after liver transplantation in a low endemic area. Two hundred twenty-six liver transplant recipients, 129 nontransplanted patients with chronic liver disease, and 108 healthy controls were tested for HEV antibodies. HEV RNA was investigated in all sera from transplanted patients. HEV antibodies were detected in 1 healthy control (1%), 4 patients with chronic liver disease (3%), and 10 liver transplant recipients (4%). Three liver transplant patients also tested positive for HEV RNA. Two of them developed persistent viremia with HEV genotype 3. The patients were anti-HEV immunoglobulin G-negative and HEV RNA-negative before transplantation and had an episode of acute hepatitis 5 or 7 months after transplantation, which led to advanced liver fibrosis after 22 months in 1 patient. Seroconversion to anti-HEV occurred not before 4 months after the first detection of HEV RNA. The possibility of reverse zoonotic transmission was experimentally confirmed by the infection of 5 pigs with a patient's serum. The pigs showed histological inflammation in the liver, and HEV RNA was detectable in different organs, including muscle. In conclusion, the prevalence of HEV infection in Central European liver transplant recipients is low; however, chronic hepatitis E may occur and needs to be considered in the differential diagnosis of graft hepatitis. The diagnosis of HEV infection should be based on HEV RNA determination in immunosuppressed patients. We suggest that immunocompromised individuals should avoid eating uncooked meat and contact with possibly HEV-infected animals. Liver Transpl 16: 74-82, 2010. Infection with hepatitis E virus (HEV) usually results in acute, self-limiting hepatitis in immunocompetent individuals. 1 Acute hepatitis E may rarely progress to fulminant hepatic failure, which more often occurs in pregnant women 2 and patients with alcoholism and chronic liver diseases. 3 HEV is a single-stranded, non-
Human Pathology: Case Reports, 2018
Hepatitis E virus (HEV) infection in immunocompetent individuals is uncommon in the United States. We report a case of elderly man who presented with jaundice, cholestatic hepatitis, and subacute liver failure with fatal outcome. The patient was started on steroids based on ANA positivity. Liver biopsy showed panlobular hepatitis with cholestasis. The histologic differential diagnosis included drug/toxic injury, biliary obstruction, and acute hepatitis C or hepatitis E. Drug/toxic injury was favored initially. However, subsequent serology was positive for anti-HEV IgM and IgG, and HEV RNA genotype 3 was detected in both serum and liver tissue. Awareness of autochthonous hepatitis E and its inclusion in the differential diagnosis is needed for early diagnosis and appropriate management.
Fatal course of an autochthonous hepatitis E virus infection in a patient with leukemia in Germany
Infection, 2011
An acute infection with hepatitis E virus (HEV) genotype 3 subtype c was diagnosed in a patient with chronic lymphatic B-cell leukemia 6 weeks after the infusion of donor lymphocytes. Despite intensive care the patient died 39 days after admission due to pericardial effusion that was related to acute liver failure. We suggest that diagnostic procedures for detection of HEV infection should be seriously considered for the immunocompromised patient with elevated liver enzymes in the absence of a travel history to HEV endemic countries.
Role of Hepatitis E Virus Infection in Acute-on-Chronic Liver Failure
BioMed research international, 2018
Chronic liver disease (CLD) with a variety of causes is currently reported to be one of the main causes of death worldwide. Patients with CLD experience deteriorating liver function and fibrosis, progressing to cirrhosis, chronic hepatic decompensation (CHD), end-stage liver disease (ESLD), and death. Patients may develop acute-on-chronic liver failure (ACLF), typically related to a precipitating event and associated with increased mortality. The objective of this review was to analyze the role of acute hepatitis E virus (HEV) infection in patients with CLD, focusing on the impact of this infection on patient survival and prognosis in several world regions.
Hepatitis E Virus Infection in a Liver Transplant Recipient in the United States: A Case Report
2013
Background. Chronic infection with hepatitis E virus (HEV) has recently been recognized in immunocompromised or immunosuppressed individuals. Case Report. We report a case of concurrent HEV and human herpes virus-6 (HHV-6) infection, documented by serum HEV RNA and HHV-6 DNA, in an orthotopic liver transplant (OLT) recipient in the United States, where HEV genotype 3 infection, although prevalent, is considered to be self-limited and almost always asymptomatic. The coinfection was accompanied by elevated serum aminotransaminases, liver biopsies demonstrating chronic hepatitis, and the presence of HEV RNA in the tissue. After lowering of immunosuppressive therapy and 2 courses of valganciclovir, sequential clearance of the viruses and normalization of the serum aminotransaminases were observed. Conclusions. HEV infection can lead to chronic hepatitis in OLT recipients, and evaluation of this virus should be considered in immunosuppressed individuals with unexplained liver test abnormalities.