Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature

Bazerbachi, Fateh; Haffar, Samir; Garg, Sushil Kumar; Lake, John R.

doi:10.1093/gastro/gov042

Cited by 103 publications

(138 citation statements)

References 126 publications

(78 reference statements)

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“…Some of these extrahepatic manifestations seem to be restricted to specific HEV-genotypes. For instance, more than 50 cases of HEV-related courses of acute pancreatitis have been reported and all cases occurred in areas endemic for HEV GT 1 [62], while renal manifestations were predominantly reported in HEV GT 3 infections [63]. Extrahepatic manifestations of HEV-infection will be discussed in detail in a separate article of this issue.…”

Section: Tropical and Autochthonous Hev Infections May Lead To Difmentioning

confidence: 99%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.

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Section: Tropical and Autochthonous Hev Infections May Lead To Difmentioning

confidence: 99%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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“…Glutathione levels are already low in red blood cells of G6PD deficient subjects, however, and the further reduction due to viral hepatitis precipitates severe hemolysis 6,7. A recent review of all such cases reported to date suggested that renal failure occurs in the setting of high bilirubin levels, but the exact cause remained undetermined 8. It has been proposed that acute tubular necrosis and mechanical tubular obstruction due to hematin and bilirubin may contribute 7.…”

Section: Discussionmentioning

confidence: 99%

Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection

Shrestha

Malik

Mallick

et al. 2016

JCTH

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Acute viral hepatitis is usually a self-limiting illness. However, it can lead to complications that can be life-threatening, such as acute liver failure. Glucose 6 phosphate dehydrogenase (G6PD) deficiency in the setting of acute viral hepatitis can lead to a massive hemolysis, manifesting as acute kidney injury and markedly raised bilirubin levels; although cases are rare. Here, we report such a case. The patient had a viral hepatitis E infection and presented with kidney injury requiring dialysis. Examination showed very high mixed hyperbilirubinemia due to massive intravascular hemolysis. The patient experienced a long, protracted course of illness, requiring renal replacement therapy with other supportive management, which led to improvement over a period of four weeks. This case highlights the importance of recognizing associated hemolysis in a patient with viral hepatitis who presents with very high bilirubin levels or associated kidney injury. Such patients will require aggressive supportive care with prompt fluid and electrolyte management.

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“…Till date hardly more than 30 to 50 cases of acute pancreatitis due to hepatitis E have been reported, out of which the largest series of 16 patients was reported from SGPGI, Lucknow. 5 Apart from pancreatitis, HEV can also cause extra-hepatic manifestations 6 such as neurological symptom, kidney injury, haematological manifestation, etc. Most cases of Acute Pancreatitis associated with infection with hepatotropic viruses have been reported in the setting of ALF.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Acute Pancreatitis Associated With Acute Hepatitis E Virus Infection

Himanshu¹,

Pathak²,

Das³

2016

jemds

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The coincidence of viral hepatitis and acute pancreatitis is well described. Most of the cases are related to acute hepatitis A or B; however, pancreatitis due to Hepatitis E Virus (HEV) infections are rare. Most cases of acute pancreatitis is associated with fulminant viral hepatitis; however, acute pancreatitis occurring in non-fulminant hepatitis is less commonly documented. The case presented here describes moderate pancreatitis in a young male, manifesting during the course of a non-fulminant acute hepatitis E infection. KEYWORDSAcute Pancreatitis, Hepatitis E, Fulminant, Non-Fulminant. In spite of its rarity, the physician should remain alert to the possibility of pancreatitis in a patient of acute hepatitis E. Symptoms such as severe abdominal pain, restlessness or shock must warrant a search for underlying pancreatitis. It is important to recognise it at an early stage, as early constitution of treatment can help prevent the mortality associated with pancreatitis. HOW TO CITE THIS ARTICLE: CASE REPORTA 21-year-male presented to the emergency in Patna Medical College with a history of severe abdominal pain and restlessness for two days. He was apparently well fifteen days back; he then complained of yellowish discoloration of urine followed by the sclera. Associated symptoms included anorexia, nausea, low-grade fever and arthralgia. He was taking advice from a local physician for these complaints with no improvement in symptoms. The day before admission in our hospital, he complained of severe epigastric pain which exacerbated on lying down and on taking meals. The pain was severe in intensity and did not respond to over-the-counter analgesics. The next day he felt restless and complained of diaphoresis and was rushed to our emergency. At the time of admission, he was restless and perspiring excessively. His pulse rate was 120/minute and he had a Blood Pressure of 70/40 mmHg. General examination revealed icterus with a greenish tinge and mild pallor. Abdominal examination revealed generalised tenderness and guarding over the epigastric area. No organs were palpable and the liver span was normal. Chest examination was normal. The cardiovascular examination was normal, but for tachycardia. Financial or Other, Competing Interest: None. Submission 27-07-2016, Peer Review 24-08-2016, Acceptance 30-08-2016, Published 08-09-2016. Corresponding Author: Dr. Kumar Himanshu, Junior Resident, Department of Medicine, Patna Medical College, Patna. E-mail: rgtc2008@gmail.com DOI: 10.14260/jemds/2016/1206 Nervous system examination did not show any abnormality. The patient had never consumed alcohol, had never suffered from cholelithiasis or related diseases, had no history of any significant drug intake or any surgical procedures or history of any abdominal trauma, nor had he ever suffered from chronic medical illnesses such as Diabetes or Hypertension or Dyslipidaemia. His family history did not reveal anything significant.A presumptive diagnosis of Acute Hepatitis complicated by Pancreatitis was made ...

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Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature

Cited by 103 publications

References 126 publications

Acute Hepatitis E: Two Sides of the Same Coin

Acute Hepatitis E: Two Sides of the Same Coin

Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection

An Unusual Case of Acute Pancreatitis Associated With Acute Hepatitis E Virus Infection

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