title: A case report: two patients with fulminant hepatitis E in Hokkaido, Japan.
abstract: Hepatitis E virus (HEV) has been listed as one of the major agents that cause fulminant hepatitis in HEV-endemic areas, but not in non-endemic areas. Recently, however, we experienced two cases of fulminant hepatitis E in Hokkaido, Japan: case-1 was a 34-year-old woman and case-2, a 51-year-old man, neither having a history of travelling outside Japan or contact with travellers abroad or foreigners. HEV RNA was detected in their acute-phase serum and sequencing analyses indicated that they were infected with different strains of HEV: genotype III in case-1 and IV in case-2. Case-1 patient deceased after liver transplantation, while case-2 patient survived. Based on these cases, we suggest that HEV should be considered as an aetiologic agent for fulminant hepatitis, even in non-endemic areas.
authors.affiliation: Center for Gastroenterology, Teine Keijinkai Hospital, 006-8555, Sapporo, Japan
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Ohnishi
authors.forename: Jong Hon
authors.initials: JH
authors.lastname: Kang
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maekubo
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Takahashi
authors.forename: Shunji
authors.initials: S
authors.lastname: Mishiro