戊型肝炎病毒感染病例：腹膜透析患者肝损伤的鉴别诊断之一。
A Case of Hepatitis E Virus Infection: One of Differential Diagnosis of Liver Injury in Patients Undergoing Peritoneal Dialysis.
作者信息
Yan Tomohiro, Sakai Yukinao, Terada Kohsuke, Okano Sho, Kawasaki Sayuri, Kashiwagi Tetsuya, Iwabu Masato
机构信息
Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
出版信息
Int Med Case Rep J. 2022 Oct 10;15:557-561. doi: 10.2147/IMCRJ.S385393. eCollection 2022.
BACKGROUND
There are numerous causes of liver function disorder in patients undergoing peritoneal dialysis (PD). Infection with the Hepatitis E virus (HEV) is a rare cause of liver injury, and the behavior of HEV in patients with PD is unclear. Since patients undergoing dialysis are frequently polypharmatic, liver injury caused by HEV infection may be misdiagnosed as drug-induced liver injury.
CASE PRESENTATION
A 61-year-old woman with PD developed abrupt elevation of blood transaminase levels on a routine outpatient session. Since the patient has been receiving tolvaptan as the only new medication, we suspected tolvaptan induced liver injury. In further investigating the cause of liver injury, the blood screening test was found to be positive for HEV-IgA. The patient was diagnosed with HEV infection, and had a self-limited course.
CONCLUSION
When encountered with patients developing liver injury during PD, HEV infection should be included in the differential diagnosis.
背景
接受腹膜透析（PD）的患者出现肝功能障碍的原因众多。戊型肝炎病毒（HEV）感染是肝损伤的罕见原因，且HEV在PD患者中的表现尚不清楚。由于透析患者常使用多种药物，HEV感染所致肝损伤可能被误诊为药物性肝损伤。
病例报告
一名61岁接受PD治疗的女性患者在常规门诊时出现血转氨酶水平突然升高。由于该患者一直在使用托伐普坦作为唯一的新药，我们怀疑是托伐普坦引起的肝损伤。在进一步调查肝损伤原因时，发现血液筛查检测HEV-IgA呈阳性。该患者被诊断为HEV感染，病程呈自限性。
结论
当遇到PD期间发生肝损伤的患者时，鉴别诊断应包括HEV感染。
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