A case of fulminant hepatic failure caused by hepatitis E virus

Recent studies reported finding hepatitis E virus (HEV) in sera of domestic animals in Japan and also that HEV is a causative agent of non-A, non-B, non-C acute hepatitis and fulminant hepatitis. To clarify the incidence and severity of the disease caused by HEV in Hiroshima, Japan, we studied 97 patients with acute sporadic hepatitis. Stored serum samples were analysed for markers of hepatitis viruses. Only one patient, who developed fulminant hepatitis that was indistinguishable from acute exacerbation of autoimmune hepatitis (AIH), and died of liver failure, was positive for IgM and IgG antibodies against HEV by enzyme-linked immunosorbent assay and for HEV RNA by reverse transcription-polymerase chain reaction. Nucleotide sequence analyses of cDNA showed that the isolate, HA-Hir1, belongs to genotype III of HEV. A careful study of the life style of the patient failed to identify the infectious route. Although the incidence was not high, we considered that HEV was an important causative agent of severe hepatitis and the clinical features of acute hepatitis E were sometimes indistinguishable from those of acute exacerbation of AIH.