New foe treated with old guns - supportive role of steroids in the treatment of acute severe hepatitis E.
BACKGROUND
Autochthonous hepatitis E has been observed with growing incidence in industrialized countries. Hepatitis E virus infection causes an acute hepatitis with spontaneous resolution in the majority of cases. However, in individual cases, hepatitis E may lead to life-threatening acute liver failure. In this report, we describe a case of acute liver injury caused by an autochthonous hepatitis E that resolved under steroid treatment. To our knowledge, this is the first case report describing supportive steroid monotherapy for acute liver injury due to hepatitis E.


METHODS
A 63-year-old Caucasian male presented with acute liver injury of unknown origin. After excluding the most prevalent causes of acute liver injury, liver histology revealed signs of immune-mediated toxic or drug-induced liver injury. Therefore, immunosuppressive treatment with prednisolone was started. After initialization of steroid treatment, polymerase chain reaction analyses of peripheral blood and liver tissue revealed an acute hepatitis E virus infection (genotype 3). Under sustained steroid treatment, acute liver injury improved and hepatitis E infection resolved.


CONCLUSIONS
Steroid treatment might be an option to prevent progress of life-threatening liver failure and liver transplantation in patients with hepatitis E-induced acute liver injury and high-grade inflammation.
Marcial
M
Sebode
Sven
S
Pischke
Marc
M
Lütgehetmann
Susanne
S
Polywka
Alexander
A
Quaas
Ansgar W
AW
Lohse
Henning
H
Wege
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D016751:Hepatitis E / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D011239:Prednisolone