Liver cirrhosis due to hepatitis E in a kidney transplant patient

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 154; p. A1790
• Main Authors: Verhoeven, Yolanda, Bac, Dirk-Jan, Feith, Geert W
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 2010
• Subjects: Biopsy; Fatal Outcome; Female; Hepatitis E - complications; Hepatitis E - diagnosis; Humans; Kidney Transplantation; Liver - pathology; Liver Cirrhosis - diagnosis; Liver Cirrhosis - virology; Middle Aged
• ISSN: 0028-2162; 1876-8784

Until recently, hepatitis E was considered to be an infectious disease that resolved without any long-term complications. We describe a 47-year-old woman who presented with a decompensated liver cirrhosis with ascites and peripheral oedema, 14 years after successful kidney transplantation. A previous extensive analysis of persistent liver enzyme disorders had not yielded a diagnosis, whereas now laboratory tests showed slightly abnormal liver results. The CT scan revealed ascites with signs of a decompensated liver cirrhosis. A liver biopsy revealed an active micronodular cirrhosis. Serological tests into the usual infectious causes of hepatitis provided no conclusive evidence but PCR on hepatitis E virus RNA and ELISA on virus-specific IgM and IgG were both positive on 2 occasions, suggestive for an active hepatitis E infection, the probable cause of the cirrhosis. The patient died several weeks later as a consequence of hepatic and renal failure. Hepatitis E was previously regarded as a travel-related disease from endemic areas. However, it is increasingly being observed in Western countries as well, where infection can take place due to intensive contact with animals and the consumption of infected meat.