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Published on: June 26, 2020
Acute hepatitis E virus infection as a trigger for postinfectious IgA nephropathy: A rare case report
Musawer Khan1, Zarafshan Khan1, Ashfaq Altaf1
1Department of Nephrology, Combined Military Hospital Quetta, Quetta, Pakistan.
Rationale:
IgA nephropathy (IgAN) is most often idiopathic but may occur following infections. While associations with hepatitis B and C are recognized, its link with acute hepatitis E virus () infection is rarely described and remains poorly understood.
Patient Concerns:
A 37-year-old male presented with fever, sore throat, vomiting, generalized weakness, and dark-colored urine for 2 days.
Diagnoses:
Laboratory evaluation showed markedly elevated liver enzymes, hyperbilirubinemia, and acute kidney injury. Hepatitis E IgM was positive. Renal biopsy demonstrated postinfectious IgA nephropathy with mesangial hypercellularity and moderate acute tubular injury.
Interventions:
The patient received supportive therapy, including intravenous fluids, hemodialysis, plasma exchange, and corticosteroid treatment with intravenous methylprednisolone followed by an oral prednisolone taper.
Outcomes:
Renal function progressively improved. By 3 months, serum creatinine decreased from 703 µmol/L at admission to 135 µmol/L, with resolution of symptoms and no recurrence of hematuria or renal impairment.
Lessons:
This case suggests that acute HEV infection may act as a trigger for postinfectious IgA nephropathy. Clinicians should consider IgAN in patients with HEV who develop renal dysfunction, as timely recognition and management can substantially improve outcomes.
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