title: Acute hepatitis E mimicking a flare of disease in a patient with chronic autoimmune hepatitis.
abstract: Acute hepatitis E is becoming increasingly recognised in Europe with up to 40% of the population in Southern France being exposed to the virus, which is harboured in pigs. Patients with known liver disease may present with acute hepatitis E and present a diagnostic challenge. For example patients with autoimmune hepatitis (AIH) who are immunosuppressed and contract hepatitis E may be at increased risk of developing chronicity due to concurrent immunosuppression. Importantly, the diagnosis may be missed with the infection misdiagnosed as an autoimmune flare, and immunosuppression increased by the attending physician, thus enhancing the risk of chronicity of infection leading to progressive liver injury in immunocompromised patients. We report a case of acute hepatitis E in a patient with AIH and discuss the features that helped us differentiating it from an autoimmune flare.
authors.affiliation: Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Calisti
authors.affiliation: Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.
authors.forename: Dianne N
authors.initials: DN
authors.lastname: Irish
authors.affiliation: Blood Borne Virus Unit, MS-Colindale, Public Health England, London, United Kingdom.
authors.forename: Samreen
authors.initials: S
authors.lastname: Ijaz
authors.affiliation: Blood Borne Virus Unit, MS-Colindale, Public Health England, London, United Kingdom.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Tedder
authors.affiliation: Centre for Hepatology, Royal Free and University College Medical School, University College London, United Kingdom.
authors.forename: Kevin
authors.initials: K
authors.lastname: Moore
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D016751:Hepatitis E / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011237:Predictive Value of Tests
chemical_list: D007166:Immunosuppressive Agents