Acute hepatitis E virus infection presenting as a prolonged cholestatic jaundice

Area of Science:

• Hepatology
• Virology
• Gastroenterology

Background:

• Hepatitis E virus (HEV) is an enteric virus causing hepatitis, endemic in Israel but without recent reported outbreaks.
• While typically self-resolving, HEV can be severe, particularly in pregnant women.

Observation:

• A 70-year-old man presented with painless jaundice and gallstones, with no signs of biliary obstruction.
• Initial investigations for gallstones and other common causes of jaundice were negative.
• Liver biopsy revealed an acute cholestatic pattern.

Findings:

• Hepatitis E virus RNA was detected in acute-phase serum, confirming HEV infection.
• The patient experienced prolonged cholestatic jaundice, resolving over six months.
• This case represents a unique presentation of chronic cholestatic jaundice attributed to acute HEV infection.

Implications:

• This case underscores HEV as a potential etiology for prolonged cholestatic jaundice, even in the absence of typical risk factors or outbreaks.
• Highlights the importance of considering HEV in the differential diagnosis of unexplained cholestasis.
• Suggests HEV infection can manifest with atypical, prolonged cholestatic features beyond typical acute hepatitis.