BackgroundRecently, chronic hepatitis E has been increasingly reported in organ transplant recipients in European countries. In Japan, the prevalence of hepatitis E virus (HEV) infection after transplantation remains unclear, so we conducted a nationwide cross-sectional study to clarify the prevalence of chronic HEV infection in Japanese liver transplant recipients.MethodsA total of 1893 liver transplant recipients in 17 university hospitals in Japan were examined for the presence of immunoglobulin G (IgG), IgM and IgA classes of anti-HEV antibodies, and HEV RNA in serum.FindingsThe prevalence of anti-HEV IgG, IgM and IgA class antibodies was 2.9% (54/1893), 0.05% (1/1893) and 0% (0/1893), respectively. Of 1651 patients tested for HEV RNA, two patients (0.12%) were found to be positive and developed chronic infection after liver transplantation. In both cases, HEV RNA was also detected in one of the blood products transfused at the perioperative period. Analysis of the HEV genomes revealed that the HEV isolates obtained from the recipients and the transfused blood products were identical in both cases, indicating transfusion-transmitted HEV infection.InterpretationThe prevalence of HEV antibodies in liver transplant recipients was 2.9%, which is low compared with the healthy population in Japan and with organ transplant recipients in European countries; however, the present study found, for the first time, two Japanese patients with chronic HEV infection that was acquired via blood transfusion during or after liver transplantation.

Recognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.

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Giant cell arteritis (GCA) is a granulomatous arteritis containing giant cells that occur in the major branches of the aorta. Headache is frequently the first symptom, but oral symptoms may precede it. We report a case where giant cell arteritis presented as pain and swelling of the tongue with necrosis over time.The patient was a 78-year-old woman. She became aware of tongue pain and swelling from June 2019 and visited a nearby dental clinic. Her symptoms remained unimproved and was referred to our department in the same month for detailed examination and treatment. At her first visit, a painful, poorly-marginated dark purple mass was found extending from the left lateral edge of tongue to the proglossis. A vascular anomaly of the tongue was suspected, and contrast-enhanced MRI was performed but did not lead to a diagnosis. One week later, necrotic lesions were observed on her tongue and a blood test showed elevated inflammatory markers. A systemic disease was suspected, and medical examination at our hospital led to the diagnosis of GCA. Steroid

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