Field Zachary, Russin Michelle, Murillo Alvarez Rodrigo M, Madruga Mario, Carlan Steve
Internal Medicine, Orlando Regional Medical Center, Orlando, USA.
Pathology, Orlando Regional Medical Center, Orlando, USA.
Cureus. 2020 Sep 24;12(9):e10628. doi: 10.7759/cureus.10628.
Immunocompromised patients are particularly at risk to develop hepatitis E virus (HEV) infection and its related complications. We present a rare case of HEV infection in a 35-year-old Hispanic female with concomitant acute myeloid leukemia (AML). The patient presented with acute liver failure within a few weeks after receiving a blood transfusion. Our case likely represented an acute de novo HEV infection after chemotherapy in a patient with concurrent AML, evidenced by the presence of anti-HEV IgM antibodies as well as histological findings, and with a previous history of recent transfusions being one of the strongest risk factors for transmission. Liver failure from an acute de novo hepatitis E infection with concurrent AML can be catastrophic in the immunosuppressed patient. Our case is particularly unique due to the uncommon presentation of acute hepatitis E in a non-pregnant reproductive aged Hispanic female with recently diagnosed AML. Clinicians should maintain a low threshold to test serum HEV-RNA if a patient presents with signs and symptoms suggestive of acute hepatitis.
免疫功能低下的患者特别容易感染戊型肝炎病毒（HEV）及其相关并发症。我们报告了一例罕见的戊型肝炎病毒感染病例，患者为一名35岁的西班牙裔女性，同时患有急性髓系白血病（AML）。该患者在输血后几周内出现急性肝衰竭。我们的病例可能代表了一名并发急性髓系白血病的患者在化疗后发生的急性原发性戊型肝炎病毒感染，抗HEV IgM抗体的存在以及组织学检查结果证明了这一点，近期输血史是传播的最强危险因素之一。急性原发性戊型肝炎感染并发急性髓系白血病导致的肝衰竭，对于免疫抑制患者可能是灾难性的。我们的病例尤为独特，因为在一名最近诊断为急性髓系白血病的非妊娠育龄西班牙裔女性中，急性戊型肝炎的表现并不常见。如果患者出现提示急性肝炎的体征和症状，临床医生应保持较低的血清HEV-RNA检测阈值。
