A Transfusion-transmitted Chronic Hepatitis E Virus Infection after Allogeneic Bone Marrow Transplantation with Viral Clearance Following Immunosuppression Tapering

A hepatitis E virus (HEV) infection is typically self-limiting in immunocompetent individuals, but it may cause chronic persistent or fulminant hepatitis in immunocompromised hosts. We report the case of a 62-year-old woman with myelofibrosis who developed chronic hepatitis E due to transfusion-transmitted HEV genotype 3 infection after allogeneic bone marrow transplantation, which was confirmed by positivity for anti-HEV IgA and HEV RNA, as well as the viral RNA sequence identity between the transfusion donor and recipient. Liver dysfunction appeared two months after transfusion and worsened despite tacrolimus escalation for suspected graft-versus-host disease, but it resolved after tacrolimus tapering alone. Although foodborne transmission is common, transfusion and other unidentified sources can also cause an HEV infection. An HEV should be considered when a patient shows posttransplant liver dysfunction.