Background: Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing regions. In high-income countries, hepatitis E is an emergent zoonotic disease of increasing concern. Clinically, the infection is usually acute and self limited in immunocompetent individuals, though rare chronic cases in immunocompromised patients have been reported. Both acute and chronic infections have been recently associated with several extrahepatic manifestations including neurological and hematological disorders.
Case Report: A case of autochthonous chronic HEV infection in a liver transplanted man from a non-endemic country is presented. Phylogenetic analysis revealed a swine origin of the HEV human infection. Chronic hepatitis E was treated with a 9-week course of Ribavirin, when viral clearence was achieved. Afterwards, the patient developed a post-transplant lymphoproliferative disorder (PTLD) in the form of Burkitt`s lymphoma. At the time of lymphoma diagnosis the patient had shown a strong reactivation of Epstein-Barr virus (EBV) infection. After additional antiviral gancyclovir therapy and chemotherapy, the patient had a complete recovery with no sequelae.
Conclusions: The differential diagnosis of persistently elevated transaminases in transplanted patients and/or immunocomprimised should include testing of HEV by appropiate nucleic acid techniques (NAT´s). Cases of HEV infection with an atypical clinical outcome, as the one presented herein, highlights the need for increased awareness of chronic hepatitis E and its association with a wide range of extrahepatic manifestations.
