title: Acute hepatitis E virus infection presenting as a prolonged cholestatic jaundice.
abstract: Hepatitis E virus (HEV) is an enteric virus that usually causes a self-resolving hepatitis; although, it may be fatal, especially in pregnant women. Although HEV is endemic in Israel, there have been no recent local outbreaks. We report the case of a 70-year-old man who presented with painless jaundice. Ultrasound and abdominal computed tomography scan revealed gallstones, with no evidence of cholecystitis and no dilatation of the intra-or extrahepatic bile ducts. An open cholecystectomy was performed with intraoperative cholangiography. There was no evidence of choledocholithiasis. A subsequent endoscopic retrograde cholangiopancreatography was normal. His bilirubin level subsequently increased to a maximum of 25 mg/dL, and his gamma-glutamyl-transferase level reached 1,400 U/L. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin G to hepatitis A virus. A liver biopsy revealed an acute cholestatic picture. The jaundice resolved slowly after a period of 6 months. Hepatitis E virus RNA was isolated from the acute-phase serum and was not detectable in the convalescent serum. This case is a unique example of chronic cholestatic jaundice that we think is caused by acute HEV infection.
authors.affiliation: Division of Internal Medicine, Kaplan Medical Center, Rehovot, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Mechnik
authors.forename: N
authors.initials: N
authors.lastname: Bergman
authors.forename: M
authors.initials: M
authors.lastname: Attali
authors.forename: M
authors.initials: M
authors.lastname: Beergabel
authors.forename: B
authors.initials: B
authors.lastname: Mosenkis
authors.forename: N
authors.initials: N
authors.lastname: Sokolowski
authors.forename: S
authors.initials: S
authors.lastname: Malnick
mesh_terms: D000208:Acute Disease; D000368:Aged; D002779:Cholestasis / Q000209:etiology*; D016751:Hepatitis E / Q000150:complications*; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D013997:Time Factors
chemical_list: D012367:RNA, Viral