A Patient with Clinical Features of Acute Hepatitis E Viral Infection and Autoimmune Hepatitis

Nagasaki, Futoshi; Ueno, Yoshiyuki; Mano, Yutaka; Igarashi, Toshihiro; Yahagi, Kaichiro; Niitsuma, Hiroaki; Okamoto, Hiroaki; Shimosegawa, Tooru

doi:10.1620/tjem.206.173

Cited by 25 publications

(17 citation statements)

References 35 publications

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“…Exogenous factors, such as viruses and drugs, have been proposed as triggers for AIH. There have been occasional cases presenting shortly after documented infection with hepatitis A virus [4,5], cytomegalovirus [6], Epstein Barr virus (EBV) [7] and hepatitis E virus (HEV) [8,9]. This supports the evidence of the initiating role of hepatitis viruses in the development of AIH and other autoimmune diseases [10].…”

Section: Introductionmentioning

confidence: 71%

Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

Gerven

Eijk

Pas

et al. 2016

JGLD

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Background & Aims: In recent years chronic courses of hepatitis E virus (HEV) infection have been described in immunosuppressed individuals. This may implicate a potential role for HEV in the development of autoimmune diseases, including autoimmune hepatitis (AIH). Here we investigated the prevalence of HEV-antibodies in AIH patients in an endemic Central European country. Methods: HEV-specific immunoglobulin G (IgG) and HEV RNA were determined in 354 and 377 AIH patients, respectively. Clinical characteristics and disease outcome parameters were retrospectively collected. Results: No HEV viraemic patients were identified in this cohort. A total of 106 AIH patients (29.9%) tested positive for anti-HEV IgG, and this figure was slightly higher compared to the prevalence in a reference cohort including 5,329 healthy Dutch blood donors (26.7%; P>0.05). Conclusion: This is the largest study on the association between HEV infection and AIH. Apparently silent HEV infection is present in a significant proportion of AIH patients, yet appears not to have significant clinical repercussions in this immune compromised group of patients. Nevertheless, since acute hepatitis E may present with histological and biochemical features of AIH, the possibility of a (concomitant) HEV infection should be considered in this category of patients.Abbreviations: AIH: autoimmune hepatitis; ALT: alanine aminotransferase; SMA: anti smooth muscle antibodies; ANA: antinuclear antibodies; PBC: primary biliary cirrhosis; AMA: anti mitochondrial antibodies; PSC: primary sclerosing cholangitis.

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Section: Introductionmentioning

confidence: 71%

Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

Gerven

Eijk

Pas

et al. 2016

JGLD

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“…One of the two patients had cirrhosis of unknown etiology, but a definitive diagnosis of autoimmune hepatitis could not be made. Some authors have reported a rare association of past exposure to hepatitis E and the occurrence of autoimmune hepatitis or primary biliary cirrhosis, suggesting a possible role in the development of autoimmune liver disease, similar to that seen in hepatitis A [14,17]. However, no histological data about these cases are available.…”

Section: Discussionmentioning

confidence: 99%

“…The largest series of patients with autochthonous hepatitis E have been described in the Barcelona area and the Toulouse area on both sides of the Pyrénées mountains [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Evidence exists that some animals can be reservoirs for HEV.…”

Section: Introductionmentioning

confidence: 99%

Liver histology in patients with sporadic acute hepatitis E: a study of 11 patients from South-West France

et al. 2007

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Hepatitis E virus is a ribonucleic acid (RNA) enterically transmitted virus that causes both epidemics and sporadic cases of acute hepatitis E in many countries of Asia and Africa. Domestically acquired (non-travel-associated) hepatitis E has been reported recently in many industrialized countries including the USA, Europe, and Japan. There is little information available on liver histology in these patients. We report a series of 11 patients with sporadic acute hepatitis E and needle liver histology in South-West France. Hepatitis E was diagnosed based on elevated transaminases (>10 upper limit normal) and the presence of specific serum antibodies (immunoglobulin-G class, present in all 11 patients) and/or viral RNA detection in serum and/or stools. Acute hepatitis lesions were observed in all cases with marked necro-inflammatory activity in nine patients. Confluent necrosis was present in five cases. Anisocaryosis and Kupffer's cell aggregates with siderosis were observed in most of the 11 patients. Cholangitis was frequent (9/11 cases). Cholestasis was observed in eight cases. Pseudo-glandular pattern was present in only one case but without zonal repartition. Characteristic pathological signs of acute hepatitis E were severe intralobular necrosis, polymorph inflammation, and acute cholangitis with numerous neutrophils.

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“…Thus, we administered PSL, and serum transaminase levels promptly improved without a relapse after the discontinuation of PSL. Some patients with acute hepatitis E are reported to demonstrate elevation of serum IgG levels and positivity of autoantibodies and to respond to corticosteroid treatment (12)(13)(14). Their clinical features are similar to those of AIH with acute onset form.…”

Section: Discussionmentioning

confidence: 96%

“…Thus, we speculate that, in some patients with acute hepatitis E, autoimmune response may be associated with the pathogenesis. On the other hand, in acute hepatitis E treated with PSL, PSL has been reported to be tapered and discontinued without the exacerbation of the disease (12). Furthermore, the administration of corticosteroid was not shown to be associated with the persistent infection of HEV (16).…”

Section: Discussionmentioning

confidence: 99%

Acute Hepatitis due to Hepatitis E Virus Genotype 1 As an Imported Infectious Disease in Japan

et al. 2010

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An 18-year-old Nepalese man was admitted due to general malaise and anorexia a month after coming to Japan. Laboratory tests showed elevation of transaminase and positivity for IgM anti-HEV antibody. Serum HEV RNA was detected by RT-PCR amplifications. An HEV genome phylogenetic tree, constructed using an 821-nucleotide sequence in the open reading frame 1, indicated that the genotype was 1. HEV genotype 1 is epidemic in South Asia, Africa and South America, and the incidence of acute hepatitis due to HEV genotype 1 is low in Japan. Thereafter, attention should be paid to HEV genotype 1 infection as an imported infectious disease.

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A Patient with Clinical Features of Acute Hepatitis E Viral Infection and Autoimmune Hepatitis

Cited by 25 publications

References 35 publications

Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

Liver histology in patients with sporadic acute hepatitis E: a study of 11 patients from South-West France

Acute Hepatitis due to Hepatitis E Virus Genotype 1 As an Imported Infectious Disease in Japan

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