Chronic hepatitis E infection with an emerging virus strain in a heart transplant recipient successfully treated with ribavirin: a case reportReportar como inadecuado

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Journal of Medical Case Reports

, 9:180

First Online: 26 August 2015Received: 18 February 2015Accepted: 13 July 2015DOI: 10.1186-s13256-015-0655-z

Cite this article as: Waldenström, J., Castedal, M., Konar, J. et al. J Med Case Reports 2015 9: 180. doi:10.1186-s13256-015-0655-z


IntroductionDuring the last decade hepatitis E infections have been recognized as a health problem in high-income countries, where hepatitis E virus genotype 3 is endemic. The infection is often self-limiting, but may develop into chronic infection in immunocompromised patients, especially in solid organ recipients. If these patients or patients with underlying liver disease get hepatitis E infection, they may develop liver failure and cirrhosis. Hepatitis E virus is occasionally found in blood products and transfusion transmission has been reported. We present the first case of chronic hepatitis E infection in a heart transplant recipient in Sweden.

Case presentationA 63-year-old Swedish white man presented with highly elevated liver enzymes 6 months after heart transplantation. Polymerase chain reaction revealed chronic hepatitis E infection, caused by a virus strain found infecting symptomatic cases in Sweden and other European countries. During transplantation, he received blood products from 17 donors, and transfusion transmission is highly likely. The only detectable marker for hepatitis E infection was hepatitis E virus ribonucleic acid for more than 2 months before anti-hepatitis E virus developed. He was treated successfully with ribavirin and decreased immunosuppression.

ConclusionsOur patient was probably infected through contaminated blood products and subsequently developed chronic infection, which was cured upon treatment. This highlights the need for evaluating the problem with chronic hepatitis E infection in immunocompromised patients, and for discussion concerning screening of blood products. Polymerase chain reaction-based methods are recommended for diagnosing hepatitis E infection in patients with compromised immunity. In addition, knowledge needs to be gained on the infecting virus strain, which may be more virulent than other strains.

KeywordsChronic Genotype 3 Heart transplant Hepatitis E virus HEV Ribavirin Transfusion transmitted  Download fulltext PDF

Autor: Jesper Waldenström - Maria Castedal - Jan Konar - Kristjan Karason - Martin Lagging - Helene Norder


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