Case Report: Chronic hepatitis E in a hematopoietic stem cell transplant recipient: The first report of hepatitis E virus genotype 4 causing chronic infection in a non-solid organ recipient

Abstract

Hepatitis E virus (HEV) is one of the most important public health issues around the world, and chronic HEV infection has been reported in immunosuppressed individuals. This study reported a male case, with very severe aplastic anemia (AA), who developed chronic hepatitis E after hematopoietic stem cell transplantation (HSCT). Abnormal alanine aminotransferase (ALT) appeared after HSCT and persisted for twenty-nine months. The case was seropositive for anti-HEV IgG and IgM after HSCT. Twenty-two months after HSCT, HEV RNA and antigen (Ag) testing were positive and persisted for five and seven months, respectively. Positive stains of HEV Ag were present in a liver biopsy sample. HEV Ag was present in bone marrow. The individual rapidly developed liver cirrhosis and was rescued by a regimen of oral ribavirin. These factors suggested there is a risk of HEV infection in HSCT recipients.

Recent advances in hepatitis E virus research and the Japanese clinical practice guidelines for hepatitis E virus infection

“…278 Chen et al reported a case of chronic HEV-4 infection in a hematopoietic stem cell transplant recipient with severe aplastic anemia, although it is unknown when he was infected with HEV. 279 Hepatitis E virus infection may be involved in development of aplastic anemia in some cases.…”

“…(A‐1) HEV genotypes 3 and 4 may cause chronic infection in immunocompromised hosts, notably in SOT patients 61,90,91,151,246,247 . (B‐2) Attention should be directed toward the extrahepatic manifestations of HEV infection 266–318 . (B‐1)…”

“…Attention should be directed toward the extrahepatic manifestations of HEV infection 266–318 . (B‐1)…”