Acute Hepatitis E Virus infection with coincident reactivation of Epstein-Barr virus infection in an immunosuppressed patient with rheumatoid arthritis: a case report.

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Serval ID
serval:BIB_A1B52C584081
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Acute Hepatitis E Virus infection with coincident reactivation of Epstein-Barr virus infection in an immunosuppressed patient with rheumatoid arthritis: a case report.
Journal
Bmc Infectious Diseases
Author(s)
Schultze D., Mani B., Dollenmaier G., Sahli R., Zbinden A., Krayenbühl P.A.
ISSN
1471-2334 (Electronic)
ISSN-L
1471-2334
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
15
Pages
474
Language
english
Notes
Publication types: Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
BACKGROUND: Hepatitis E virus (HEV) is the most recently discovered of the hepatotropic viruses, and is considered an emerging pathogen in developed countries with the possibility of fulminant hepatitis in immunocompromised patients. Especially in the latter elevated transaminases should be taken as a clue to consider HEV infection, as it can be treated by discontinuation of immunosuppression and/or ribavirin therapy. To our best knowledge, this is a unique case of autochthonous HEV infection with coincident reactivation of Epstein-Barr virus (EBV) infection in an immunosuppressed patient with rheumatoid arthritis (RA).
CASE PRESENTATION: A 68-year-old Swiss woman with RA developed hepatitis initially diagnosed as methotrexate-induced liver injury, but later diagnosed as autochthonous HEV infection accompanied by reactivation of her latent EBV infection. She showed confounding serological results pointing to three hepatotropic viruses (HEV, Hepatitis B virus (HBV) and EBV) that could be resolved by detection of HEV and EBV viraemia. The patient recovered by temporary discontinuation of immunosuppressive therapy.
CONCLUSIONS: In immunosuppressed patients with RA and signs of liver injury, HEV infection should be considered, as infection can be treated by discontinuation of immunosuppression. Although anti-HEV-IgM antibody assays can be used as first line virological tools, nucleic acid amplification tests (NAAT) for detection of HEV RNA are recommended--as in our case--if confounding serological results from other hepatotropic viruses are obtained. After discontinuation of immunosuppressive therapy, our patient recovered from both HEV infection and reactivation of latent EBV infection without sequelae.
Keywords
Aged, Arthritis, Rheumatoid/immunology, Arthritis, Rheumatoid/virology, Coinfection, Epstein-Barr Virus Infections/diagnosis, Epstein-Barr Virus Infections/drug therapy, Female, Hepatitis Antibodies/blood, Hepatitis B virus/immunology, Hepatitis B virus/pathogenicity, Hepatitis E/drug therapy, Hepatitis E/virology, Herpesvirus 4, Human/immunology, Herpesvirus 4, Human/pathogenicity, Humans, Immunocompromised Host, Immunosuppressive Agents/therapeutic use, Ribavirin/therapeutic use
Pubmed
Web of science
Open Access
Yes
Create date
01/12/2015 17:49
Last modification date
20/08/2019 15:07
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