title: Asymptomatic acute hepatitis E in a female patient with ulcerative colitis.
abstract: We present a 60-year-old female patient with asymptomatic acute hepatitis E that was fortuitously detected during the course of ulcerative colitis (UC). She was admitted to hospital on October 30, 2015. Endoscopy and histological examination of the colon showed typical findings of UC. All parameters of liver function tests were normal on this date. Combination therapy with oral prednisolone and mesalazine was started and intravenous administration of infliximab once every 8 weeks was added later. Her symptoms gradually improved after these treatments, and she was discharged on February 7, 2016. In a periodic check-up on July 7, 2016, high levels of serum transaminases were detected in liver function tests. Although drug-induced liver injury was first suspected, anti-hepatitis E virus (HEV) immunoglobulin A was positive. The genotype and subgenotype of this HEV are 3 and 3a, respectively, although the infectious route of the HEV was unclear. Within 2 weeks after the onset of acute liver injury, the HEV viremia disappeared and her liver function tests improved. Examination of serum anti-HEV immunoglobulin A should be added at the time of abnormal liver function tests in patients with UC receiving immunosuppressive and biological drugs.
authors.affiliation: Department of Nutritional Science, Morioka University, 808 Sunakomi, Takizawa, Iwate, 020-0694, Japan. kasuzuki@morioka-u.ac.jp.|Department of Gastroenterology, Morioka City Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan. kasuzuki@morioka-u.ac.jp.|Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. kasuzuki@morioka-u.ac.jp.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Gastroenterology, Morioka City Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kumagai
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Miyasaka
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takikawa
authors.affiliation: Department of Gastroenterology, Morioka City Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kamiya
authors.affiliation: Department of Gastroenterology, Morioka City Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
authors.forename: Kouryo
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Department of Gastroenterology, Morioka City Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Kato
authors.affiliation: Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University School of Dentistry, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Chiba
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
mesh_terms: D000208:Acute Disease; D058345:Asymptomatic Infections; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D005260:Female; D016751:Hepatitis E / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D007166:Immunosuppressive Agents
keywords: Acute hepatitis E; Biological drug; Immunosuppressive drug; Opportunistic infection; Ulcerative colitis