Yeh Chau-Ting, Yeh Christopher Sung-Huan, Chu Yu-De, Chiang Yang-Jen
Liver Research Center, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kuei-Shan District, Taoyuan, Taiwan.
Department of Cognitive Science, College of Letters and Science, University of California Los Angeles, Los Angeles, USA.
J Med Case Rep. 2018 Feb 28;12(1):50. doi: 10.1186/s13256-018-1586-2.
Hepatitis E virus infection usually causes an acute and self-resolving hepatitis. In areas where chronic hepatitis B virus infection is prevalent, acute hepatitis E virus superinfection on chronic hepatitis B virus infection occurs sporadically. In recent years, however, chronic hepatitis E virus infection has been recognized in patients under immunosuppressant therapy. To the best of our knowledge, cases involving patients with chronic hepatitis E virus and hepatitis B virus dual infection have never been reported.
A 47-year-old Taiwanese woman who was a renal transplant recipient with chronic hepatitis B virus infection was under immunosuppressant and antiviral treatment. An episode of hepatitis B exacerbation developed due to withdrawal of antiviral treatment against advice, but the flare subsided following antiviral re-treatments. However, an episode of hepatitis exacerbation developed following removal of the renal graft because of graft failure. During the hepatitis flare, she was still under successful antiviral suppression against hepatitis B virus, while her serum samples were positive for hepatitis E virus RNA. Following the hepatitis flare, seroclearance of hepatitis B virus surface antigen developed. From then on, she was under regular hemodialysis. Five years later, another episode of mild hepatitis exacerbation occurred again with positive serum hepatitis E virus RNA. Tracing back the longitudinal serum samples, serum hepatitis E virus RNA was persistently positive throughout the course. This patient was thus recognized to have chronic hepatitis E virus and hepatitis B virus dual infection with intermittent hepatitis E exacerbations.
In areas where chronic hepatitis B virus infection is prevalent, chronic hepatitis E virus coinfection can occur in organ transplant recipients receiving immunosuppressant. Intermittent hepatitis E exacerbations may develop, interfering with the status of hepatitis B virus infection.
戊型肝炎病毒感染通常引起急性且可自愈的肝炎。在慢性乙型肝炎病毒感染流行的地区，戊型肝炎病毒急性重叠感染慢性乙型肝炎病毒的情况偶有发生。然而，近年来，在接受免疫抑制治疗的患者中已认识到慢性戊型肝炎病毒感染。据我们所知，从未有过慢性戊型肝炎病毒和乙型肝炎病毒双重感染患者的病例报道。
一名47岁的台湾女性，是一名接受肾移植的慢性乙型肝炎病毒感染者，正在接受免疫抑制和抗病毒治疗。因不听从建议停用抗病毒治疗，发生了一次乙型肝炎病情加重，但再次进行抗病毒治疗后病情缓解。然而，由于移植肾失功而切除移植肾后，又发生了一次肝炎病情加重。在肝炎发作期间，她对乙型肝炎病毒的抗病毒抑制治疗仍有效，而她的血清样本戊型肝炎病毒RNA呈阳性。肝炎发作后，乙型肝炎病毒表面抗原出现血清学清除。从那时起，她开始定期进行血液透析。五年后，再次发生了一次轻度肝炎病情加重，血清戊型肝炎病毒RNA呈阳性。追溯纵向血清样本，整个病程中血清戊型肝炎病毒RNA持续呈阳性。因此，该患者被诊断为慢性戊型肝炎病毒和乙型肝炎病毒双重感染，伴有间歇性戊型肝炎病情加重。
在慢性乙型肝炎病毒感染流行的地区，接受免疫抑制治疗的器官移植受者可能发生慢性戊型肝炎病毒合并感染。可能会出现间歇性戊型肝炎病情加重，干扰乙型肝炎病毒感染状态。
