title: Chronic hepatitis E infection with an emerging virus strain in a heart transplant recipient successfully treated with ribavirin: a case report.
abstract: BACKGROUND
  During the last decade hepatitis E infections have been recognized as a health problem in high-income countries, where hepatitis E virus genotype 3 is endemic. The infection is often self-limiting, but may develop into chronic infection in immunocompromised patients, especially in solid organ recipients. If these patients or patients with underlying liver disease get hepatitis E infection, they may develop liver failure and cirrhosis. Hepatitis E virus is occasionally found in blood products and transfusion transmission has been reported. We present the first case of chronic hepatitis E infection in a heart transplant recipient in Sweden.
  
  
  METHODS
  A 63-year-old Swedish white man presented with highly elevated liver enzymes 6 months after heart transplantation. Polymerase chain reaction revealed chronic hepatitis E infection, caused by a virus strain found infecting symptomatic cases in Sweden and other European countries. During transplantation, he received blood products from 17 donors, and transfusion transmission is highly likely. The only detectable marker for hepatitis E infection was hepatitis E virus ribonucleic acid for more than 2 months before anti-hepatitis E virus developed. He was treated successfully with ribavirin and decreased immunosuppression.
  
  
  CONCLUSIONS
  Our patient was probably infected through contaminated blood products and subsequently developed chronic infection, which was cured upon treatment. This highlights the need for evaluating the problem with chronic hepatitis E infection in immunocompromised patients, and for discussion concerning screening of blood products. Polymerase chain reaction-based methods are recommended for diagnosing hepatitis E infection in patients with compromised immunity. In addition, knowledge needs to be gained on the infecting virus strain, which may be more virulent than other strains.
authors: Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. jesper.waldenstrom@gu.se.
authors: Jesper
authors: J
authors: Waldenström
authors: Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. maria.castedal@vgregion.se.
authors: Maria
authors: M
authors: Castedal
authors: Department of Transfusion Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Jan.konar@vgregion.se.
authors: Jan
authors: J
authors: Konar
authors: Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. kristjan.karason@vgregion.se.
authors: Kristjan
authors: K
authors: Karason
authors: Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. martin.lagging@medfak.gu.se.
authors: Martin
authors: M
authors: Lagging
authors: Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. helene.norder@gu.se.
authors: Helene
authors: H
authors: Norder
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D016027:Heart Transplantation; D016751:Hepatitis E / Q000188:drug therapy*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012254:Ribavirin / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin