Acute hepatitis E virus infection after liver transplant is a challenging clinical phenomenon. Due to its unspecific clinical and histological presentation, the diagnosis of acute or chronic hepatitis E virus infection can be difficult in unclear cases of elevated liver enzymes. Here, we report the case of a 56-year-old male patient who presented to our center for 17-year follow-up after liver transplant with α1-antitrypsin deficiency. The patient was asymptomatic but had remarkably increased transaminases and cholestasis parameters. Blood levels for immunosuppressives were in the normal range, and cholestasis and deteriorated liver perfusion were excluded by ultrasonographic examination. A liver biopsy was performed that was histologically interpreted as acute cellular rejection grade I. Accordingly, the patient was treated with 5-day high-dose intravenous steroids and increased doses of the maintenance immunosuppressive agents, resulting in the slow normalization of the liver enzymes. Extended laboratory examinations revealed presence of acute hepatitis E virus infection, and a retrospectively immunohistologic staining of the liver biopsy was positive for hepatitis E virus antigen. Acute hepatitis E virus infection can be a reason for acute allograft dysfunction after liver transplant. This differential diagnosis should be kept in mind, especially when graft dysfunction occurs long after transplant.

Background and Aim: Jaundice and associated liver disease are frequently diagnosed in patients with acquired immunodeficiency syndrome (AIDS). The assessment of jaundice causes, etiology, and outcomes in human immunodeficiency virus (HIV)-infected patients with liver disease have not been addressed. The present study aimed to evaluate jaundice and associated liver disease in human immunodeficiency virus (HIV)-infected patients. Materials and Methods: This cross-sectional study was conducted on 272 human immunodeficiency virus(HIV)-infected patients with liver disease at the Department of Gastroenterology AK CMH/ Sheikh Khalifa bin Zayad Al Nahyan Hospital Rawalakot, Medicine Medical Unit A, Hayatabad Medical Complex, Peshawar and department of Medicine, Fauji Foundation Hospital Rawalpindi for duration between 5th January 2020 and 5th December 2020. Jaundice was defined as a serum bilirubin concentration of 3 mg/dL or higher. The etiology of jaundice was determined using a pattern of liver disease biochemistry test, radiographic studies, liver biopsy and clinical follow-up. Results: About 272 HIV-infected patients were evaluated liver disease; the prevalence of jaundice was 46 (16.9%). Drug-induced hepatitis was the more prevalent cause in Jaundice 19 (41.3%) followed by neoplasms in 14 (30.4%) patients. Out of 14 neoplasms, the extrahepatic and intrahepatic disease was present in 8 and 6 patients respectively. Alcoholic liver disease was present in 5 (10.9%). Various potential causes were present in three patients. The use of abdominal ultrasonography and CT was beneficial in determining the fundamental cause of the infection. five of these patients died as a result of liver disease. Conclusion: Jaundice is rare and can be caused by a number of opportunistic and non-opportunistic etiologies in AIDS. The most common cause is drug-induced hepatitis, which can be fatal. Long-term survival was dismal. Keywords: Jaundice, Liver Disease, Human immunodeficiency virus (HIV)

Objective: The study aimed to analyze the distribution and frequency of individuals diagnosed with histopathologically non-plaque-induced gingival lesions and categorize them according to the non-plaque-induced gingival disease classification published at the 2017 World Workshop of Periodontology. Materials and Methods: Clinical features of the gingival lesion with histopathological diagnosis data in the period 1998-2003 were retrospectively analyzed . The lesions were classified as reactive lesions, malignant neoplasms, premalignant neoplasms, autoimmune disorders, benign neoplasms, hypersensitive reactions, and genetic lesions. Their distribution according to age, gender, histopathological diagnosis, and oral sites was examined. Variables were analyzed using descriptive statistics. Results: Among a total of 217 biopsied gingival samples, the most frequent pathologic nature of biopsied non-plaque gingival lesions were reactive lesions (n = 80, 36.87%) and premalignant neoplasms (n = 64, 29.49%). In addition, the 5 most frequent types of all cases included pyogenic granuloma (n = 45, 20.74%), epithelial dysplasia (n = 40, 18.43%), papilloma (n = 33, 15.21%), epithelial hyperplasia (n = 24, 11.06%), and calcifying fibroblastic granuloma (n = 13, 5.99%). Conclusions: In a Turkish population, the most frequently biopsied non-plaque-induced gingival lesions were reactive lesions and premalignant neoplasms. This study shows that the types of lesions that clinicians, in general, especially periodontologists, can expect to encounter in their practice are the most frequently applied gingival lesions.