Hepatitis E Virus Infection Caused Elevation of Alanine Aminotransferase Levels in a Patient with Chronic Hepatitis B and Choledocholithiasis

Abstract

Hepatitis E virus (HEV) genotypes 3 and 4 are zoonotic strains that are primarily transmitted through the consumption of undercooked pork or game meat. They also cause asymptomatic infections, acute hepatitis, acute-on-chronic liver failure, chronic hepatitis, and extrahepatic manifestations. Here, we report a man in his 80s who had chronic hepatitis B, took entecavir for it, and presented with higher levels of alanine aminotransferase (ALT) and jaundice. An abdominal computed tomography scan revealed choledocholithiasis with cholecystolithiasis. Although endoscopic papillary balloon dilatation was performed for the removal of a common bile duct stone, the abnormal liver function tests, including jaundice, were prolonged. After other viral hepatitis and other causes of the liver injury were ruled out, as his serum was positive for immunoglobulin A anti-HEV and HEV genotype 3b RNA, we diagnosed him as having acute hepatitis E. In this case, with chronic hepatitis B and a common bile duct stone, the prolonged abnormal results for the liver function tests seemed to be caused by HEV infection. In conclusion, in cases with high ALT levels after removing choledocholithiasis, other factors, including HEV infection, should be considered to determine the cause of abnormal liver function test results. The further examination of hepatitis D virus infection and high ALT levels may be needed in HBV-infected individuals.

Severe hepatitis E virus genotype 3b in a patient with alcohol‑associated liver disease: A case report

“…The peak ALT level was 1,067 IU/l in the present case. High ALT levels may provide an indication for the diagnosis of acute HEV infection ( 21 , 23 ). Barbosa et al ( 21 ) also used ribavirin in 3 patients; however, in the present study, ribavirin could not be used due to renal dysfunction.…”

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

“…Acute hepato-biliary tract and pancreatic diseases other than hepatitis may be associated with HEV infection. 176,285,[302][303][304][305][306][307][308] Among patients with rheumatoid arthritis, HEV infection is occasionally observed, and the presence of HEV infection should be evaluated immediately in those with liver dysfunction. [309][310][311][312][313][314][315] Myocarditis, 316 autoimmune thyroiditis, 317 and myasthenia gravis 318 are also reported in HEV infection.…”