Hepatitis E during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Ikeuchi, Hidekazu; Koinuma, Kana; Nakasatomi, Masao; Sakairi, Toru; Kaneko, Yoriaki; Maeshima, Akito; Yamazaki, Yuichi; Okamoto, Hiroaki; Mimura, Toshihide; Mochida, Satoshi; Nojima, Yoshihisa; Hiromura, Keiju

doi:10.1155/2018/6873276

Cited by 9 publications

(16 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although case reports of hepatitis E infection in patients with RA are accumulating, [9,21,22,23] little is known on the course of HEV infection in patients with inflammatory rheumatic disorders. We reported a case of patients with RA with hepatitis E that developed during leflunomide therapy in combination with low-dose steroids.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-six cases of hepatitis E developed during the treatment of RA with DMARDs were reported in a recent literature review [21] . In particular, 20 patients were treated with targeted synthetic (ts) or bDMARDs with or without csDMARDs and 6 patients with csDMARDs, namely methotrexate, bucillamine, mizoribine, actarit, and tacrolimus; low-dose steroids were used in 16 cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hepatitis E infection in a patient with rheumatoid arthritis treated with leflunomide

et al. 2019

View full text Add to dashboard Cite

Rationale:Hepatitis E is an infectious disease due to inflammation of the liver caused by hepatitis E virus (HEV) and represents one of the most common causes of acute hepatitis and jaundice in the world. Although data of hepatitis E infection in patients with rheumatoid arthritis (RA) are accumulating, little is known on the course of HEV infection. We reported, for the 1st time, a case of patient with RA with hepatitis E that developed during leflunomide therapy in combination with low-dose steroids.Patient concerns:We present a 39-year-old woman, affected by RA and treated with leflunomide, reported diffuse itching and persistent fatigue laboratory data revealed elevated liver enzyme levels.Diagnosis:Positivity for anti-HEV IgM and IgG was observed. HEV-RNA of the genotype 3 was detected, indicating acute E hepatitis.Interventions and outcomes:Leflunomide was stopped and restarted 5 months after the initial diagnosis at the same dosage, with a close clinical and laboratory follow-up. The virus was eradicated from the serum without chronic transformation. The patient is alive and well 7 months after the initial diagnosis.Lessons:To our knowledge, this report is the 1st case of acute E hepatitis in a patient with RA developed during leflunomide therapy in combination with low-dose steroids. Moreover, geoepidemiology of infection is important, due to the fact that Abruzzo, a central region of Italy, has the highest HEV seroprevalence in general population, related to the zoonotic transmission of the infection from domestic and wild animals. Our case highlighted that immunosuppressive therapy, and in particular leflunomide, could be safely reintroduced after the resolution of the infection and the clearance of the virus. Further studies are needed to evaluate potential advantages in serologic testing for HEV infection as a part of the routine workup done to patients with rheumatic diseases and selected for immunosuppressive therapy.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatitis E infection in a patient with rheumatoid arthritis treated with leflunomide

et al. 2019

View full text Add to dashboard Cite

show abstract

“…We found a total of 60 cases of HEV infection (Table 1) occurring in immunosuppressed patients, treated with DMARDs, other than SOT receivers,HIV carriers or having undergone HSCT [20,28,[55][56][57][58][59].…”

Section: Hev In Patients With a Rheumatic Diseasementioning

confidence: 99%

“…In a recent literature review, 26 cases of HEV infection occurred during the treatment of RA [ 55 ]. Twenty patients were treated with ts- or b-DMARDs with or without cs-DMARDs, 6 patients with cs-DMARDs alone, namely MTX, LEF, bucillamine, mizoribine, actarit and tacrolimus (TAC) while low-dose steroids were used in 16 cases.…”

Section: Hev In Patients With a Rheumatic Diseasementioning

confidence: 99%

“…One patient died because of acute liver failure and one patient, who continued adalimumab therapy, developed a chronic infection that resolved after adalimumab withdrawal and ribavirin treatment. In other 3 cases ribavirin was used with a rapid eradication of the virus (< 3 months), interestingly these patients were receiving Rituximab (RTX) with or without MTX [ 55 ]. In a French multicenter retrospective study among patients with various chronic inflammatory arthritis, 23 cases of HEV infections were reported [ 56 ].…”

Section: Hev In Patients With a Rheumatic Diseasementioning

confidence: 99%

See 1 more Smart Citation

Hepatitis E Virus and rheumatic diseases: what do rheumatologists need to know?

2020

View full text Add to dashboard Cite

Background Hepatitis E virus (HEV) represents the most common cause of acute hepatitis and jaundice in the world. About 2 million of infection cases occur each year in Europe, mainly as autochthonous anthropozoonosis, and HEV can be transmitted through undercooked pork meat. This infection has been linked to various extra-hepatic manifestations, while chronic infections with a rapid development of liver failure have been described in heavily immunosuppressed patients undergoing solid organ transplantations (SOTs), in patients with hematological diseases or with immunodeficiency virus infection. Main body of abstract The purpose of this review article is to describe rheumatic manifestations related to HEV infection and their implications for rheumatologists in the daily clinical practice. Despite recent accumulating literature in this field, little is known about the course of the infection in patients with rheumatic diseases (RDs) and about the impact of immunosuppressive drugs. Moreover, HEV infection can mimic RDs’ manifestations or drugs toxicity. Specific guidelines on management are lacking and the majority of data are referred to SOTs receivers. Conclusions More studies are needed to better understand the real impact of HEV infection in patients with RDs, regarding both clinical outcomes and their management.

show abstract

Hepatitis-E-Virus-Infektion bei einem Patienten mit rheumatoider Arthritis unter Baricitinib-Therapie

et al. 2021

View full text Add to dashboard Cite

ZusammenfassungEs wurde ein Patient mit rheumatoider Arthritis (RA) vorgestellt, der unter der Therapie mit dem Januskinase-1/2-Inhibitor Baricitinib eine Infektion mit dem Hepatitis-E-Virus (HEV) entwickelte. Unser Patient hatte bei seiner vierteljährlichen Routineuntersuchung deutlich erhöhte Transaminasen bei einer unauffälligen körperlichen Untersuchung. Es fanden sich Antikörper der IgM- und IgG-Klasse gegen HEV und ein erhöhtes C‑reaktives Protein (CRP) sowie HEV-RNA mittels Real-Time-PCR, was auf eine frische HEV-Infektion hinwies. Baricitinib wurde sofort abgesetzt. Die ausführliche Anamnese ergab, dass der Patient Tage vor der Konsultation Rindertartar verzehrt hatte, ohne dass gastrointestinale Symptome oder Fieber aufgetreten waren. Im weiteren Verlauf erholte sich der Patient vollständig, und die Leberfunktionstests und das CRP normalisierten sich innerhalb von 3 Monaten. Baricitinib wurde daraufhin wieder eingenommen. Bisher wurden nur wenige Daten zu HEV-Infektionen bei RA-Patienten, die mit JAK-Inhibitoren behandelt wurden, publiziert.

show abstract

Hepatitis E during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Cited by 9 publications

References 24 publications

Hepatitis E infection in a patient with rheumatoid arthritis treated with leflunomide

Hepatitis E infection in a patient with rheumatoid arthritis treated with leflunomide

Hepatitis E Virus and rheumatic diseases: what do rheumatologists need to know?

Hepatitis-E-Virus-Infektion bei einem Patienten mit rheumatoider Arthritis unter Baricitinib-Therapie

Contact Info

Product

Resources

About