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Chronic hepatitis E in immunocompromised patients shows distinct histopathology, including destructive cholangitis. The hepatitis E virus is present in bile duct epithelia, contributing to this inflammation.

Keywords:
HEV genotype 3immunohistochemistryimmunosuppressionsolid organ transplantation

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Area of Science:

  • Hepatology
  • Virology
  • Immunology

Background:

  • Sporadic hepatitis E, caused by genotype 3, is an emerging disease in Europe.
  • While typically acute in immunocompetent individuals, it can become chronic in immunocompromised patients.
  • Detailed histological descriptions of chronic hepatitis E are lacking.

Purpose of the Study:

  • To systematically describe the histology of chronic hepatitis E in immunosuppressed individuals.
  • To compare the histopathology of chronic hepatitis E with other chronic liver diseases.
  • To investigate the viral presence within liver tissues.

Main Methods:

  • Analysis of liver biopsies from 19 immunosuppressed patients with chronic hepatitis E.
  • Standard histological staining and evaluation of activity and fibrosis (Ishak score).
  • Immunohistochemistry for hepatitis E virus (HEV) open reading frame 2 and 3, and HEV RNA testing.

Main Results:

  • Biochemical tests revealed elevated liver enzymes and bilirubin.
  • Histopathology showed mild to moderate chronic hepatitis with increased polymorphonuclear leukocytes.
  • A florid, sometimes destructive, cholangitis was observed in all patients.
  • Hepatocytes and bile duct epithelia stained positive for HEV via immunohistochemistry.

Conclusions:

  • Chronic hepatitis E in the immunocompromised shares similarities with hepatitis B and C but presents unique features.
  • Destructive cholangitis and increased polymorphonuclear leukocytes are distinguishing characteristics.
  • HEV presence in bile duct epithelia suggests a role in cholangitis pathogenesis.