title: Older men with unexplained hepatitis.
abstract: A 59-year-old Caucasian man presented with painless jaundice for 6 weeks. He drank 70 units of alcohol per week. Examination revealed jaundice, spider angiomata and a 3 cm firm hepatomegaly. Initial bloods: bilirubin 152 µmol/L, alanine aminotransferase 1484 IU/L, alkaline phosphatase 130 IU/L, γ-glutamyl-transpeptidase 1224 IU/L and International Normalised Ratio 1.1. A standard liver screen was normal, and an abdominal ultrasound/CT scan suggested cirrhosis, confirmed by liver biopsy on day 5. Hepatitis E virus (HEV) serology on day 6 indicated acute infection. He developed severe hepatic decompensation characterised by worsening jaundice, ascites and variceal bleeding. On day 33 ribavirin 600 mg was initiated though discontinued after 2 weeks on receipt of a negative HEV RNA. At the last follow-up he had recovered, and remains abstinent from alcohol. We describe a case of autochthonously (locally) acquired HEV infection with life-threatening hepatic decompensation in the presence of undiagnosed alcohol-related cirrhosis.
authors.affiliation: Department of Gastroenterology & Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Kok Haw Jonathan
authors.initials: KH
authors.lastname: Lim
authors.affiliation: Department of Pathology, Brighton and Sussex University Hospitals, Brighton, Sussex, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Howard
authors.affiliation: Department of Gastroenterology & Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Jackson
authors.affiliation: Department of Gastroenterology & Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Sumita
authors.initials: S
authors.lastname: Verma
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D016751:Hepatitis E / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin