Chronic hepatitis E virus infection in a patient with leukemia and elevated transaminases: a case report
نویسندگان
چکیده
INTRODUCTION Acute hepatitis E virus infection may cause mild, self-limiting hepatitis, either as epidemic outbreaks or sporadic cases, the latter of which have been reported in industrialized countries. Chronic infections are uncommon and have been reported in immunosuppressed patients, patients with human immunodeficiency virus infection, and patients with hematological malignancies. CASE PRESENTATION A 46-year-old Caucasian man was admitted to the gastroenterology clinic with a history of increasing transaminases, persistent exhaustion, and occasional right-side abdominal pain over the course of a 6-month period. B-cell chronic lymphocytic leukemia had been diagnosed several years earlier, and the patient was treated with rituximab, pentostatin, and cyclophosphamide. A diagnostic workup ruled out autoimmune and metabolic liver disease, hepatitis A-C, and herpes virus infection. A physical examination revealed enlarged axillary lymph nodes. The results of an abdominal ultrasound examination were otherwise unremarkable. Hepatitis E virus infection was diagnosed by detection of hepatitis E virus-specific antibodies. Blood samples were positive for hepatitis E virus ribonucleic acid with high viral loads for at least 8 months, demonstrating a rare chronic hepatitis E virus infection. Sequencing and phylogenetic analysis revealed hepatitis E virus genotype 3c with homologies to other European isolates from humans and swine, indicating an autochthonous infection. CONCLUSIONS Usually, hepatitis E virus infection appears as an acute infection; rare chronic infections have been reported for transplant patients, patients with human immunodeficiency virus, and patients with hematological malignancies. The chronic nature of hepatitis E infection in our patient was most likely induced by the immunosuppressive B-cell chronic lymphocytic leukemia treatment. The differential diagnosis in patients with unexplained hepatitis should include hepatitis E virus infection, and appropriate laboratory analyses should be considered.
منابع مشابه
Severe muscle weakness during treatment with pegylated interferon alfa for chronic hepatitis C virus infection A rare complication
Background: Interferons (IFNs) are common therapeutics for several diseases such as viral hepatitis, multiple sclerosis and malignancy. A variety of autoimmune related side effects have been observed during IFN therapy. Rare cases of myopathy, polymyositis or dermatomyositis have been reported during therapy with high doses of IFN^5. Case Presentation: In this report, we describe a case with se...
متن کاملPseudoporphyria in association with Hepatitis C virus infection: A case report
Pseudoporphyria is an uncommon bullous disease with similar clinical and histopathological findings to porphyria cutanea tarda, in the absence of detectable porphyrin elevation. We present a 34-year-old man with clinical and histological findings compatible with porphyria cutanea tarda, whose his urinary uroporphyrin was negative and we concluded that he was a case of pseudoporphyria. Concomita...
متن کاملPersistent Hepatitis E Virus Genotype 4 Infection in a Child With Acute Lymphoblastic Leukemia
INTRODUCTION In general, the hepatitis E virus (HEV) causes acute, self-limiting hepatitis. Prolonged and chronic infections caused by HEV genotype 3 have been found in some immunosuppressed patients in developed countries. CASE PRESENTATION Here we report a Chinese boy with acute lymphoblastic leukemia, who developed hepatitis E during a period of intensive chemotherapy. Twenty months after ...
متن کاملHepatitis B Virus Infection in Patients with Blood Disorders: A Concise Review in Pediatric Study
Childhood Hepatitis B virus (HBV) infection causes both medical and public health challenges. Infants who acquire HBV parentally have up to 90% risk of developing chronic HBV infection. It is now estimated that approximately 10% of worldwide cancers are attributable to viral infection, with the vast majority (>85 %) occurring in the developing world. In this distribution, elevated rate and prev...
متن کاملA Case of Hairy Cell Leukemia Associated with Hepatitis B Surface (HBs) Antigenemia and Concurrent Hepatitis C Virus (HCV) Seropositivity
Literature review shows that hepatitis C infection may increase the risk of non-hodgkin lymphoma. Reactivation of hepatitis B infection has been reported in patients with hairy cell leukemia after chemotherapy and/or splenectomy. We present hepatitis B surface (HBs) antigenemia and concurrent hepatitis C virus (HCV) seropositivity in a case of hairy cell leukemia. Key Words: Hairy cell leukemi...
متن کامل