Severe acute hepatitis E infection presenting with acute abdomen and meningoencephalitis

Abstract

We present a case of a 50-year-old man admitted due to acute abdomen, icterus and fever. The patient had a history of sufficiently treated type 2 diabetes and a high daily alcohol consumption, no recent travel history and had a strictly heterosexual and monogamous way of living. A full blood count displayed severe elevated liver enzymes. A CT of the abdomen was performed and revealed steatosis but no acute abdominal pathology. During admission, the patient developed signs of meningoencephalitis. A lumbar puncture was performed, and the cerebrospinal fluid revealed lymphocytic pleocytosis consistent with mild inflammation. Furthermore, hepatitis E was found in the blood and the definitive diagnosis was established. The patient gradually recovered and was discharged within 8 days of admission. To the best of our knowledge, we present the second case describing concomitant hepatitis and meningoencephalitis, resolving spontaneously and not giving rise to sequelae.

Fatal Fulminant Hepatitis E in a Diabetic Patient on Metformin

“…Wenter et al reported the case of a 78-year-old immunocompetent diabetes patient, who presented with symptomatic infection by a genotype 3 virus and progressed to acute liver insufficiency [ 8 ]. Ribavirin treatment rapidly lowered the HEV RNA load and led to complete resolution of acute fulminant hepatitis E. Gynthersen et al reported the case of a 50-year-old type 2 diabetic, alcoholic patient admitted for jaundice, fever, and a painful abdomen and who developed meningoencephalitis symptoms [ 9 ]. This patient gradually improved clinically within 8 days post-hospitalization.…”

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

“…Several reports have documented severe cases of hepatitis E in individuals with diabetes mellitus. [236][237][238][239] Consequently, clinicians should exercise caution to prevent progression to severe liver disease among patients with both HEV infection and diabetes mellitus.…”

Hepatitis E Virus Infection: Neurological Manifestations and Pathophysiology

“…Meningoencephalitis has been described in a few patients [41,43,[64][65][66] but HEV RNA was not always detected in their CSF. One patient was diagnosed by metagenomics next-generation sequencing following CSF analysis.…”