title: Management of acute HVE infection in a patient treated with rituximab for rheumatoid arthritis.
abstract: BACKGROUND
  Acute E hepatitis becomes more frequent in immunocompromised patients. No guidelines are available to date for the management of this infection and of the immunosuppressive treatment.
  
  
  METHODS
  We report a case of acute E hepatitis treated with ribavirine in a patient known for rheumatoid arthritis and treated with rituximab.
  
  
  METHODS
  A 51-year-old woman known for rheumatoid arthritis and treated with rituximab was hospitalized for a jaundice secondary to an acute E hepatitis. She was treated with ribavirin 800mg twice a day during 2 months with a good efficacy and tolerance. Finally, 3 months after the acute E hepatitis, she benefited from 2 new 1000mg rituximab infusions because of the rheumatoid arthritis activity. The treatment was well tolerated without acute hepatitis. The follow-up of the HVE infection was realized with HVE PCR in the blood and 8 months after the last infusions, there were no chronic courses or acute hepatitis recurrence.
  
  
  CONCLUSIONS
  This case highlights the safety and the efficacy of the reintroduction of rituximab after 2 months of treatment with ribavirin and a negative PCR.
authors.affiliation: Department of rheumatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Verhoeven
authors.affiliation: Department of hepatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Weil-Verhoeven
authors.affiliation: Department of hepatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.affiliation: Department of rheumatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Prati
authors.affiliation: Department of hepatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Thevenot
authors.affiliation: Department of rheumatology, CHRU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon, France. Electronic address: dwendling@chu-besancon.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
mesh_terms: D000208:Acute Disease; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D016751:Hepatitis E / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use*; D000069283:Rituximab / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018501:Antirheumatic Agents; D000998:Antiviral Agents; D012254:Ribavirin; D000069283:Rituximab
keywords: Acute hepatitis E; Rheumatoid arthritis; Rituximab