Acute hepatitis E in a renal transplantation recipient: a case report

Area of Science:

• Hepatology
• Transplant Medicine
• Infectious Diseases

Background:

• Hepatitis E virus (HEV) infection typically causes self-limiting hepatitis but can lead to chronic disease in immunosuppressed individuals.
• Organ transplant recipients are a vulnerable population for severe HEV outcomes.
• Acute hepatitis E is infrequently reported in transplant recipients.

Observation:

• A 31-year-old male renal transplant recipient presented with fatigue and fever.
• Initial liver function tests showed dysfunction, with negative serology for common hepatitis viruses and cytomegalovirus.
• A history of consuming undercooked pork was noted, and initial HEV-IgA tests were negative.

Findings:

• Subsequent testing revealed positive HEV-IgA and HEV-RNA (genotype 3), confirming acute hepatitis E.
• Liver function normalized, and viral markers became negative within 11 weeks.
• Diagnosis was aided by a detailed dietary history and serial HEV-IgA measurements.

Implications:

• This case highlights the importance of considering HEV in transplant recipients with unexplained liver dysfunction.
• Thorough patient interviews regarding foodborne exposures are crucial for diagnosis.
• Repeated serological testing may be necessary to confirm HEV infection in this population.