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Area of Science:

  • Hepatology
  • Transplantation Immunology
  • Virology

Background:

  • Immunosuppressive therapy post-kidney transplantation increases susceptibility to opportunistic infections.
  • Chronic hepatitis E is an emerging concern in solid organ transplant recipients.
  • Management of chronic hepatitis E is complex due to comorbidities and treatment interactions.

Observation:

  • A 38-year-old male kidney transplant recipient presented with asymptomatic, isolated alanine aminotransferase elevation.
  • Serological testing confirmed active hepatitis E virus infection, diagnosed as chronic hepatitis E.
  • The patient had concurrent chronic anemia and desired fertility treatment, complicating therapeutic decisions.

Findings:

  • Ribavirin therapy led to a rapid decrease in serum hepatitis E virus RNA levels.
  • Despite viral load reduction, fecal shedding of the virus persisted post-treatment initiation.
  • Current treatment guidelines for chronic hepatitis E lack defined durations, especially concerning fecal shedding.

Implications:

  • Persistent fecal shedding of hepatitis E virus post-treatment may indicate a risk of viral recrudescence.
  • Treatment duration for chronic hepatitis E should be extended until fecal virus clearance is achieved.
  • This case underscores the challenges in managing chronic hepatitis E in immunocompromised patients with complex medical histories.