Acute hepatitis E presenting with clinical feature of autoimmune hepatitis

Patel, Ishan; Companioni, Rafael Ching; Bansal, Raghav; Vyas, Neil; Catalano, Carmine; Aron, Joshua; Walfish, Aaron

doi:10.3402/jchimp.v6.33342

Cited by 15 publications

(16 citation statements)

References 10 publications

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“…Since HEV is a zoonosis in industrialized countries and severe courses of autochthonous infections in immunosuppressed patients were reported, AIH patients should be counselled to avoid uncooked/undercooked food potentially infected with hepatitis E virus . Furthermore, case reports of acute HEV misdiagnosed as acute AIH have been published . Some of the patients described in these reports showed elevated IgG levels and positive autoantibody patterns strongly indicative for AIH as well as at least a “probable” diagnosis according to the established scoring systems.…”

Section: Discussionmentioning

confidence: 99%

“…16 Furthermore, case reports of acute HEV misdiagnosed as acute AIH have been published. [37][38][39][40][41] Some of the patients described in these reports showed elevated IgG levels and positive autoantibody patterns strongly indicative for AIH as well as at least a "probable" diagnosis according to the established scoring systems. A study from…”

Section: Con Clus Ionsmentioning

confidence: 93%

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High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

Eder

Straßl

Beinhardt

et al. 2018

Liver International

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Background & Aims Increasing numbers of autochthonous hepatitis E virus infections have been reported in Europe. Chronic infections have been shown in immune‐compromised patients after solid organ transplantation. Hepatitis E virus might be a possible trigger for autoimmune hepatitis and might cause disease flares or relapses in the further course of disease. Aim of this study was to investigate the presence of hepatitis E virus antibodies and hepatitis E virus RNA, and to analyse their impact on immunosuppressive treatment in patients with autoimmune hepatitis. Methods Sera from 92 autoimmune hepatitis patients (73/79.3% female, age: 42.2 ± 16.3 years [mean ± SD]) were tested. Patients were scored according to the simplified and revised scoring systems of the International Autoimmune Hepatitis Group. The prevalence of anti‐ hepatitis E virus antibodies (Beijing Wantai Biological Pharmacy Enterprises Co., Ltd, Beijing, China) and hepatitis E virus RNA was determined. Results 19/20.7% autoimmune hepatitis patients tested positive for hepatitis E virus‐IgG, which was higher than in previous reports of healthy Austrian individuals (12.4%, P = 0.031); hepatitis E virus RNA was not detectable in any patient. Anti‐hepatitis E virus positive patients were older (49.5 ± 9.5 vs 40.4 ± 17.2 years [mean ± SD], P = 0.033) but did not differ in laboratory findings at diagnosis (AST: 14.6 [1.3‐70.6] vs 9.5 [0.7‐62.7] × ULN [median/range]; P = 0.387, alanine aminotransferase: 18.3 [1.6‐62.7] vs. 12.9 [0.8‐62.6] × ULN; P = 0.511; IgG: 1.4 [1.0‐2.5] vs 1.3 [0.6‐3.8] g/dL × ULN; P = 0.278) nor in alanine aminotransferase levels after six months (0.7 [0.5‐2.4] vs 1.0 U/L × ULN [0.1‐22.4]; P = 0.077). Conclusions No chronic hepatitis E virus infection was observed in our cohort of autoimmune hepatitis patients. Anti‐ hepatitis E virus‐IgG positive patients were older and the seroprevalence was nearly twice as high as reported previously in healthy Austrian individuals, suggesting that hepatitis E virus‐infection might act as trigger for the development of autoimmune hepatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Con Clus Ionsmentioning

confidence: 93%

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

Eder

Straßl

Beinhardt

et al. 2018

Liver International

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“…Patel et al reported a case of acute hepatitis E mimicking AIH in a 32‐year‐old Bengali man, who recovered completely after supportive care. They suggested that steroid therapy should be postponed until HEV is ruled out 8 . Calisti et al 9 reported a case of acute hepatitis E in a patient with longstanding AIH under immunosuppressive therapy, which was mimicking a flare of AIH in a 44‐year‐old British woman.…”

Section: Discussionmentioning

confidence: 99%

A case of acute liver failure due to hepatitis E virus, liver transplantation, and development of de novo autoimmune hepatitis

Choi

Ahn

Cho

et al. 2020

Transplant Infectious Dis

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Acute liver failure (ALF) is the rapid loss of liver function due to severe injury to the liver cells, frequently leading to fatal outcomes over days or weeks, usually in previously healthy individuals. Liver transplantation (LT) is a life-saving treatment in approximately 30% of ALF patients who failed to respond to medical treatment. The cause of ALF is diverse including hepatotoxins, viral infection such as the hepatitis A, B, C, D, and E virus, hepatic ischemia, and autoimmune hepatitis. 1 Among them, the hepatitis E virus (HEV) is a positive-strand RNA virus with a 7.2 kb genome transmitted by the fecal-oral route. HEV is currently the most common cause of viral hepatitis globally, as reported by the World Health Organization (WHO): an estimated 20 million HEV infections, 3.3 million symptomatic cases, and 44 000 deaths in 2015. 2 However, there is a massive underestimation of the true burden of HEV infection due to a lack of knowledge among clinicians and the absence of a diagnostic gold standard. 3 HEV is a major cause of ALF in the Indian subcontinent and parts of Africa, but there are no case reports of ALF due to HEV infection in South Korea yet. De novo autoimmune hepatitis (AIH) rarely develops in LT recipients under immunosuppressive therapy who underwent LT due to non-AIH causes, but it shows nearly identical histological features to that of AIH. 4 Here, we report the first case of de novo AIH in a LT recipient after HEV-induced ALF, which suggests that HEV could have Abstract Acute hepatitis E virus (HEV) infection could lead to acute liver failure (ALF), which requires liver transplantation (LT). HEV infection could progress to chronic infection in an immunosuppressed host. De novo autoimmune hepatitis (AIH) is a rare occurrence of AIH during post-LT immunosuppressive therapy in patients who underwent LT due to not AIH but some other etiology. Here, we report the first case of ALF due to HEV infection, the recurrence of HEV after LT that responded to ribavirin therapy, and then the development of de novo AIH showing a complete response to glucocorticoid therapy but multiple relapses after steroid withdrawal. This peculiar case suggests that HEV could have a pathogenic role in the development of the de novo AIH; additionally, this case report could help clinicians make therapeutic decisions in the post-LT condition. K E Y W O R D S acute liver failure, autoimmune hepatitis, hepatitis E virus, liver transplantation How to cite this article: Choi JK, Ahn S, Cho JY, et al. A case of acute liver failure due to hepatitis E virus, liver transplantation, and development of de novo autoimmune hepatitis. Transpl Infect Dis. 2020;22:e13287. https://doi.

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“…HEV infection can cause asymptomatic, anicteric or icteric acute hepatitis as well as fulminant hepatitis, or acute‐on‐chronic liver failure. Moreover, this infection may not be readily recognized at times, as it may masquerade as DILI, AIH or with myriad of extrahepatic manifestations, such as neurological symptoms, acute pancreatitis, chronic renal disease and cryoglobulinaemic disease …”

Section: Discussionmentioning

confidence: 99%

Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis

Haffar¹,

Shalimar

Kaur

et al. 2018

Liver International

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Acute hepatitis E presenting with clinical feature of autoimmune hepatitis

Cited by 15 publications

References 10 publications

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

A case of acute liver failure due to hepatitis E virus, liver transplantation, and development of de novo autoimmune hepatitis

Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis

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