title: A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis.
abstract: Hepatitis E virus (HEV) is one of the major causative agents of acute hepatitis in many developing countries. Recent intensive examination has revealed the existence of non-imported cases in industrialized countries. The patient was a 25-year-old Japanese female with acute hepatitis. Laboratory test demonstrated positive anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA) and high level of serum immunoglobulin G (IgG). The patient was negative for serum markers of hepatitis A, B or C virus infection. She demonstrated a clinical course similar to severe autoimmune hepatitis, including response to prednisolone therapy. After a few years, with the availability of tests for the serum antibodies to HEV, we examined the frozen stocked sera of the patient and found her exact diagnosis was acute hepatitis E. Although we could not detect HEV-RNA, which is positive only in limited period of acute phase, serum IgA and IgG antibodies to HEV were positive and the titer of IgA and IgG antibodies were declined with the time course. In conclusion, we must take into consideration of HEV infection for the diagnosis of acute cryptogenic hepatitis including autoimmune hepatitis. Further studies are feasible to understand the pathogenesis of liver injuries induced by HEV infections.
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai 980-8574, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Nagasaki
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ueno
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Mano
authors.forename: Takehiko
authors.initials: T
authors.lastname: Igarashi
authors.forename: Kaichiro
authors.initials: K
authors.lastname: Yahagi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Niitsuma
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000494:pharmacology; D000328:Adult; D000906:Antibodies / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016751:Hepatitis E / Q000150:complications* / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D016752:Hepatitis E virus / Q000502:physiology*; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D006801:Humans
chemical_list: D000305:Adrenal Cortex Hormones; D000906:Antibodies