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Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient
Patient: Male, 62 Final Diagnosis: Chronic hepatitis E • Burkitt’s limphoma Symptoms: Elevated liver enzymes Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology OBJECTIVE: Unusual clinical course BACKGROUND: Hepatitis E virus (HEV) is a common cause of acute hepatitis in d...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647622/ https://www.ncbi.nlm.nih.gov/pubmed/31302664 http://dx.doi.org/10.12659/AJCR.916253 |
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author | Mainardi, Victoria Gerona, Solange Ardao, Gonzalo Ferreira, Noelia Ramírez, Gabriel Arbiza, Juan Mirazo, Santiago |
author_facet | Mainardi, Victoria Gerona, Solange Ardao, Gonzalo Ferreira, Noelia Ramírez, Gabriel Arbiza, Juan Mirazo, Santiago |
author_sort | Mainardi, Victoria |
collection | PubMed |
description | Patient: Male, 62 Final Diagnosis: Chronic hepatitis E • Burkitt’s limphoma Symptoms: Elevated liver enzymes Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology OBJECTIVE: Unusual clinical course 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, although 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, after which viral clearance was achieved. Subsequently, the patient developed a post-transplant lymphoproliferative disorder (PTLD) in the form of Burkitt lymphoma. At the time of lymphoma diagnosis, the patient had shown a strong reactivation of Epstein-Barr virus (EBV) infection. After additional antiviral ganciclovir therapy and chemotherapy, the patient had a complete recovery with no sequelae. CONCLUSIONS: The differential diagnosis of persistently elevated transaminases in transplanted and/or immunocompromised patients should include testing for HEV by appropriate nucleic acid techniques (NATs). Cases of HEV infection with an atypical clinical outcome, such 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. |
format | Online Article Text |
id | pubmed-6647622 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-66476222019-08-09 Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient Mainardi, Victoria Gerona, Solange Ardao, Gonzalo Ferreira, Noelia Ramírez, Gabriel Arbiza, Juan Mirazo, Santiago Am J Case Rep Articles Patient: Male, 62 Final Diagnosis: Chronic hepatitis E • Burkitt’s limphoma Symptoms: Elevated liver enzymes Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology OBJECTIVE: Unusual clinical course 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, although 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, after which viral clearance was achieved. Subsequently, the patient developed a post-transplant lymphoproliferative disorder (PTLD) in the form of Burkitt lymphoma. At the time of lymphoma diagnosis, the patient had shown a strong reactivation of Epstein-Barr virus (EBV) infection. After additional antiviral ganciclovir therapy and chemotherapy, the patient had a complete recovery with no sequelae. CONCLUSIONS: The differential diagnosis of persistently elevated transaminases in transplanted and/or immunocompromised patients should include testing for HEV by appropriate nucleic acid techniques (NATs). Cases of HEV infection with an atypical clinical outcome, such 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. International Scientific Literature, Inc. 2019-07-14 /pmc/articles/PMC6647622/ /pubmed/31302664 http://dx.doi.org/10.12659/AJCR.916253 Text en © Am J Case Rep, 2019 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Mainardi, Victoria Gerona, Solange Ardao, Gonzalo Ferreira, Noelia Ramírez, Gabriel Arbiza, Juan Mirazo, Santiago Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient |
title | Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient |
title_full | Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient |
title_fullStr | Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient |
title_full_unstemmed | Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient |
title_short | Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient |
title_sort | locally acquired chronic hepatitis e followed by epstein-barr virus reactivation and burkitt lymphoma as a suspected extrahepatic manifestation in a liver transplant recipient |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647622/ https://www.ncbi.nlm.nih.gov/pubmed/31302664 http://dx.doi.org/10.12659/AJCR.916253 |
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