Acute liver failure due to hepatitis E infection in pregnancy

Abstract

Objetives: Hepatitis E virus (HEV) infection is usually self-limited, however in pregnancy can present an aggressive and sometimes fatal outcome. Material and methods: A 40 year-old female, from Angola, was admitted to the emergency department due to abdominal pain, nausea and vomiting. The patient was 25 weeks pregnant with an irregular prenatal care and history of hypertension, medicated with alpha-metildopa, fansidar (for malaria), fenobarbital and folic acid since the 1st trimester. Physical examination and serology revealed an acute hepatic failure with prompt emergency caesarean section and hepatic transplant, both without complications. Results and discussion: Gross examination revealed liver with 800g and a smooth, reddish and dull capsule. On cut section the hepatic parenchyma was reddish and soft, with multiple green nodules, with well-defined boundaries, all with less than 1cm. Histological evaluation showed massive hepatic necrosis mainly in acinar zones 2 and 3 without microvesicular steatosis; rare microvacuolar was observed (red oil). There was mild to moderate inflammatory infiltrate composed predominately by T-lymphocytes (CD3+) with a normal CD8+/CD4+ ratio. Gallbladder was normal. Serology showed HEV positivity. There was no vertical transmission to the newborn. Despite its rarity, HEV should be part of the differential diagnosis in acute liver failure in pregnancy, especially in patients with travel history to endemic countries.