title: Extra-hepatic manifestations of autochthonous hepatitis E infection.
abstract: BACKGROUND
  Autochthonous (locally acquired) hepatitis E is increasingly recognised in developed countries, and is thought to be a porcine zoonosis. A range of extra-hepatic manifestations of hepatitis E infection have been described, but have never been systematically studied.
  
  
  OBJECTIVE
  To report the extra-hepatic manifestations of hepatitis E virus.
  
  
  METHODS
  Retrospective review of data of 106 cases of autochthonous hepatitis E (acute n = 105, chronic n = 1).
  
  
  RESULTS
  Eight (7.5%) cases presented with neurological syndromes, which included brachial neuritis, Guillain-Barré syndrome, peripheral neuropathy, neuromyopathy and vestibular neuritis. Patients with neurological syndromes were younger (median age 40 years, range 34-92 years, P = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, P = 0.015) compared to cases without neurological symptoms [median age 64 years (range 18-88 years), median ALT 1135 IU/L]. One patient presented with a cardiac arrhythmia,twelve patients (11.3%) presented with thrombocytopenia, fourteen (13.2%) with lymphocytosis and eight (7.5%) with a lymphopenia, none of which had any clinical consequence. Serum electrophoresis was performed in 65 patients at presentation, of whom 17 (26%) had a monoclonal gammopathy of uncertain significance. Two cases developed haematological malignancies, acute myeloid leukaemia and duodenal plasmacytoma, 18 and 36 months after presenting with acute hepatitis E infection.
  
  
  CONCLUSIONS
  A range of extra-hepatic manifestations can occur with hepatitis E. Neurological and haematological features of hepatitis E infection are relatively frequent in this UK cohort, and result in significant morbidity which warrants further study.
authors.affiliation: Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Truro, Cornwall, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Woolson
authors.forename: A
authors.initials: A
authors.lastname: Forbes
authors.forename: L
authors.initials: L
authors.lastname: Vine
authors.forename: L
authors.initials: L
authors.lastname: Beynon
authors.forename: L
authors.initials: L
authors.lastname: McElhinney
authors.forename: V
authors.initials: V
authors.lastname: Panayi
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
authors.forename: R G
authors.initials: RG
authors.lastname: Madden
authors.forename: T
authors.initials: T
authors.lastname: Glasgow
authors.forename: A
authors.initials: A
authors.lastname: Kotecha
authors.forename: H C
authors.initials: HC
authors.lastname: Dalton
authors.forename: L
authors.initials: L
authors.lastname: Mihailescu
authors.forename: U
authors.initials: U
authors.lastname: Warshow
authors.forename: H S
authors.initials: HS
authors.lastname: Hussaini
authors.forename: J
authors.initials: J
authors.lastname: Palmer
authors.forename: B N
authors.initials: BN
authors.lastname: Mclean
authors.forename: B
authors.initials: B
authors.lastname: Haywood
authors.forename: R P
authors.initials: RP
authors.lastname: Bendall
authors.forename: H R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006402:Hematologic Diseases / Q000453:epidemiology*; D016751:Hepatitis E / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D016752:Hepatitis E virus / Q000235:genetics / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009422:Nervous System Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D063189:Symptom Assessment / Q000706:statistics & numerical data; D055815:Young Adult