title: [Rare acute hepatitis in a female patient with hemochromatosis: a zoonosis?].
abstract: A 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, gamma-GT [gamma-glutamyl transferase] 503 U/l). The patient's medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molecular biological tests. There was no diagnostic evidence for underlying autoimmune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patient's social environment, so that a zoonotic origin has to be discussed.
authors.affiliation: Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes, Gutenberg-Universität Mainz., Mainz, Germany. vetters@klilu.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Vetter
authors.forename: Dirk
authors.initials: D
authors.lastname: Hartmann
authors.forename: Ralf
authors.initials: R
authors.lastname: Jakobs
authors.forename: Jürgen F
authors.initials: JF
authors.lastname: Riemann
mesh_terms: D000208:Acute Disease; D000818:Animals; D003937:Diagnosis, Differential; D005260:Female; D006432:Hemochromatosis / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D016751:Hepatitis E / Q000175:diagnosis* / Q000276:immunology / Q000635:transmission; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology; D006720:Homozygote; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008111:Liver Function Tests; D008875:Middle Aged; D012367:RNA, Viral / Q000235:genetics; D013019:South Africa; D014195:Travel; D015047:Zoonoses
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral
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