Abstract
An asymptomatic 35-year-old renal transplant recipient was noted to have deranged liver function tests. Liver biopsy revealed a portal inflammatory process with mild lobular activity and portal fibrous expansion, consistent with a virally mediated process. An extensive viral screen confirmed infection with Hepatitis E virus genotype 3 (HEV-3). There is increased awareness about locally acquired Hepatitis E virus (HEV) infection in the transplant population in the UK. The important implications of this infection are becoming more apparent as progression to liver cirrhosis can occur. However, the incidence, natural history, and treatment of HEV infection in the transplant population are not well established. This report illustrates a case of delayed spontaneous clearance of the HEV infection.
Highlights
There has been increased interest in Hepatitis E virus (HEV) infection as emerging data has revealed that chronic infection can lead to progressive liver disease in immunosuppressed patients including various transplant cohorts such as heart and lung transplant recipients [1, 2]
HEV generally manifests itself as a self-limiting acute viral hepatitis, with the exception of a fulminant presentation in pregnant women and in patients with chronic liver disease, this has only been described in developing countries, mainly due to waterborne HEV genotype 1 [6]
It is known that HEV can lead to chronic hepatitis in approximately 60% of infected solid organ transplant recipients and 14.3% of these develop liver cirrhosis [5, 7, 8]
Summary
There has been increased interest in HEV infection as emerging data has revealed that chronic infection can lead to progressive liver disease in immunosuppressed patients including various transplant cohorts such as heart and lung transplant recipients [1, 2]. Chronic Hepatitis E should be considered in the differential diagnosis of elevated liver enzymes in transplant recipients. The frequency and course of these infections are not well defined. The following case report highlights the challenges involved in diagnosis and treatment of this condition in a kidney transplant recipient and illustrates a case of delayed spontaneous clearance of the infection
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