Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Transpl Infect Dis. 2020 Jun;22(3):e13287. doi: 10.1111/tid.13287. Epub 2020 Apr 23.
Acute hepatitis E virus (HEV) infection could lead to acute liver failure (ALF), which requires liver transplantation (LT). HEV infection could progress to chronic infection in an immunosuppressed host. De novo autoimmune hepatitis (AIH) is a rare occurrence of AIH during post-LT immunosuppressive therapy in patients who underwent LT due to not AIH but some other etiology. Here, we report the first case of ALF due to HEV infection, the recurrence of HEV after LT that responded to ribavirin therapy, and then the development of de novo AIH showing a complete response to glucocorticoid therapy but multiple relapses after steroid withdrawal. This peculiar case suggests that HEV could have a pathogenic role in the development of the de novo AIH; additionally, this case report could help clinicians make therapeutic decisions in the post-LT condition.
急性戊型肝炎病毒（HEV）感染可导致急性肝衰竭（ALF），需要进行肝移植（LT）。HEV 感染可在免疫抑制宿主中进展为慢性感染。在 LT 后接受免疫抑制治疗的患者中，新诊断的自身免疫性肝炎（AIH）是 AIH 的罕见情况，这些患者并非因 AIH 而是因其他某种病因而接受 LT。在此，我们报告首例因 HEV 感染导致的 ALF，LT 后 HEV 复发对利巴韦林治疗有反应，随后出现新诊断的 AIH，对糖皮质激素治疗有完全反应，但在停用类固醇后多次复发。这个特殊病例提示 HEV 可能在新诊断的 AIH 发展中具有致病性作用；此外，该病例报告可帮助临床医生在 LT 后做出治疗决策。
