title: First Case Genotype 4 Hepatitis E Infection After a Liver Transplant.
abstract: Chronic hepatitis in immunosuppressed patients because of infection with hepatitis E virus is increasingly recognized, but there is a paucity of knowledge about hepatitis E virus infection in solid-organ transplant recipients. Herein, we reported the first confirmatory case of hepatitis E virus genotype 4 infection in a 47-year-old woman who underwent a liver transplant recipient in Taiwan. The patient presented with unexplained hepatitis and severe jaundice. Hepatitis E virus RNA was present in serum and identified as the genotype 4 by reverse transcription polymerase chain reaction. Pathological findings revealed that prominent zone 3 canalicular and hepatocellular cholestasis with a few acidophilic bodies and giant cell transformation, which was typical of hepatitis E virus hepatitis. Even undergoing ribavirin treatment, she had worse cholestasis and recurrent urinary tract infections. She died from encephalopathy and sepsis 6 months after the initial presentation. So far, compared with genotype 3 hepatitis E virus hepatitis, genotype 4 hepatitis E virus infection in solid-organ transplant recipients has been reported less frequently in the literature, and that warrants further accumulation of experiences.
authors.affiliation: >From the Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Wu
authors.forename: Cheng-Maw
authors.initials: CM
authors.lastname: Ho
authors.forename: Jia-Huei
authors.initials: JH
authors.lastname: Tsai
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D017809:Fatal Outcome; D005260:Female; D005838:Genotype; D016751:Hepatitis E / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D016752:Hepatitis E virus / Q000187:drug effects / Q000235:genetics*; D006521:Hepatitis, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000235:genetics; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D012254:Ribavirin