title: Hepatitis E virus infection in a liver transplant recipient in the United States: a case report.
abstract: BACKGROUND
  Chronic infection with hepatitis E virus (HEV) has recently been recognized in immunocompromised or immunosuppressed individuals.
  
  
  METHODS
  We report a case of concurrent HEV and human herpes virus-6 (HHV-6) infection, documented by serum HEV RNA and HHV-6 DNA, in an orthotopic liver transplant (OLT) recipient in the United States, where HEV genotype 3 infection, although prevalent, is considered to be self-limited and almost always asymptomatic. The coinfection was accompanied by elevated serum aminotransaminases, liver biopsies demonstrating chronic hepatitis, and the presence of HEV RNA in the tissue. After lowering of immunosuppressive therapy and 2 courses of valganciclovir, sequential clearance of the viruses and normalization of the serum aminotransaminases were observed.
  
  
  CONCLUSIONS
  HEV infection can lead to chronic hepatitis in OLT recipients, and evaluation of this virus should be considered in immunosuppressed individuals with unexplained liver test abnormalities.
authors.affiliation: Center for Liver Diseases, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA. hte@medicine.bsd.uchicago.edu
authors.forename: H S
authors.initials: HS
authors.lastname: Te
authors.forename: J
authors.initials: J
authors.lastname: Drobeniuc
authors.forename: S
authors.initials: S
authors.lastname: Kamili
authors.forename: C
authors.initials: C
authors.lastname: Dong
authors.forename: J
authors.initials: J
authors.lastname: Hart
authors.forename: U M
authors.initials: UM
authors.lastname: Sharapov
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004279:DNA, Viral / Q000097:blood; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D005838:Genotype; D016751:Hepatitis E / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D016752:Hepatitis E virus / Q000235:genetics; D015654:Herpesvirus 6, Human / Q000235:genetics; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D019349:Roseolovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D016896:Treatment Outcome; D014481:United States; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000077562:Valganciclovir; D015774:Ganciclovir