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

Détails

Ressource 1Télécharger: 26511098_BIB_A1B52C584081.pdf (369.91 [Ko])
Etat: Public
Version: Final published version
ID Serval
serval:BIB_A1B52C584081
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Acute Hepatitis E Virus infection with coincident reactivation of Epstein-Barr virus infection in an immunosuppressed patient with rheumatoid arthritis: a case report.
Périodique
Bmc Infectious Diseases
Auteur(s)
Schultze D., Mani B., Dollenmaier G., Sahli R., Zbinden A., Krayenbühl P.A.
ISSN
1471-2334 (Electronic)
ISSN-L
1471-2334
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
15
Pages
474
Langue
anglais
Notes
Publication types: Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Résumé
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.
Mots-clé
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
Oui
Création de la notice
01/12/2015 18:49
Dernière modification de la notice
20/08/2019 16:07
Données d'usage