title: HEV infection in two referral centers in Spain: epidemiology and clinical outcomes.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) is one of the major causes of icteric hepatitis worldwide. In industrialized countries it is considered an emerging disease, as a growing number of autochthonous cases have been reported in recent years. Occasional extrahepatic manifestations have been described in the setting of HEV infection.
  
  
  METHODS
  To characterize the epidemiological pattern and clinical outcomes of new cases of HEV infection diagnosed in two referral centers during the period 2011-2013.
  
  
  RESULTS
  During the study period, four cases of self-limited acute hepatitis E after travel to endemic areas were recorded, as well as five cases of HEV infection after solid organ transplantation. Four patients failed to spontaneously clear the virus and received ribavirin monotherapy; all of them had HEV genotype-3. Ribavirin was effective in inhibiting HEV replication, although in one patient a virological relapse occurred after the end of therapy. Finally, we report a case of HEV-genotype-3 related agranulocytosis in an immunocompetent patient, resulting in a fatal outcome; this is the first case reported of its kind.
  
  
  CONCLUSIONS
  Diagnosis of HEV infection needs to be taken into consideration in patients with acute or chronic hepatitis in whom other etiologies have been excluded. Although hematological complications related to acute HEV infection are infrequent, these may affect any of the bone marrow series, even after viral clearance.
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain. Electronic address: slens@clinic.ub.es.
authors.forename: Sabela
authors.initials: S
authors.lastname: Lens
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Mensa
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Martina
authors.initials: M
authors.lastname: Gambato
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: González
authors.affiliation: Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, CIBERehd, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Torras
authors.affiliation: Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, CIBERehd, Barcelona, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.affiliation: Microbiology Department, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Costa
authors.affiliation: Microbiology Department, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Capón
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: María-Carlota
authors.initials: MC
authors.lastname: Londoño
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Mariño
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Sofía
authors.initials: S
authors.lastname: Pérez-del-Pulgar
authors.affiliation: Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Forns
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D016751:Hepatitis E / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012254:Ribavirin / Q000627:therapeutic use; D013030:Spain / Q000453:epidemiology; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: Agranulocytosis; Hepatitis E; Ribavirin; Transplantation