Suzuki Kazuyuki, Kumagai Ichiro, Yoshida Yuichi, Miyasaka Akio, Takikawa Yasuhiro, Kamiya Ryoichi, Kondo Kouryo, Kato Akinobu, Chiba Toshimi, Okamoto Hiroaki
Department of Nutritional Science, Morioka University, 808 Sunakomi, Takizawa, Iwate, 020-0694, Japan.
Department of Gastroenterology, Morioka City Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
Clin J Gastroenterol. 2017 Jun;10(3):255-260. doi: 10.1007/s12328-017-0730-7. Epub 2017 Mar 28.
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.
我们报告了一名60岁的女性患者，她患有无症状急性戊型肝炎，在溃疡性结肠炎（UC）病程中偶然被发现。她于2015年10月30日入院。结肠镜检查和结肠组织学检查显示出UC的典型表现。当日所有肝功能检查参数均正常。开始口服泼尼松龙和美沙拉嗪联合治疗，后来增加每8周静脉注射一次英夫利昔单抗。经过这些治疗后，她的症状逐渐改善，并于2016年2月7日出院。在2016年7月7日的定期检查中，肝功能检查发现血清转氨酶水平升高。虽然首先怀疑是药物性肝损伤，但抗戊型肝炎病毒（HEV）免疫球蛋白A呈阳性。尽管HEV的感染途径尚不清楚，但该HEV的基因型和亚基因型分别为3型和3a型。在急性肝损伤发作后2周内，HEV病毒血症消失，她的肝功能检查有所改善。对于接受免疫抑制和生物药物治疗的UC患者，在肝功能检查异常时应增加血清抗HEV免疫球蛋白A的检测。
