Division of Gastroenterology, Shinko Hospital, Japan.
Intern Med. 2024 Feb 1;63(3):393-397. doi: 10.2169/internalmedicine.1976-23. Epub 2023 Jun 7.
A 26-year-old Indian man who had arrived in Japan 24 days prior presented to our hospital with abdominal pain and a fever. A blood test revealed marked hepatic dysfunction, and imaging tests confirmed a diagnosis of acute hepatitis. The patient's liver function and coagulability deteriorated, and his general condition was poor. Given the possibility of fulminant hepatic failure, we initiated steroid pulse therapy. Following the initiation of steroid therapy, the patient's liver function and subjective symptoms rapidly improved. Testing revealed positive findings for IgA-hepatitis E virus, and a genetic analysis of hepatitis E identified genotype 1, which is not endemic to Japan, leading to a definitive diagnosis of imported hepatitis E infection from India. The successful response to steroid therapy highlights the potential benefit of this approach in managing severe cases of acute hepatitis E, a rare occurrence in Japan. This case underscores the importance of considering hepatitis E infection in individuals with a recent travel history to regions with high prevalence and the potential benefits of steroid therapy in managing severe cases of acute hepatitis E.
一位 26 岁的印度男性，24 天前抵达日本后出现腹痛和发热，到我院就诊。血液检查显示明显的肝功能障碍，影像学检查确诊为急性肝炎。患者的肝功能和凝血功能恶化，一般情况较差。鉴于可能发生暴发性肝衰竭，我们开始使用类固醇脉冲疗法。类固醇治疗开始后，患者的肝功能和主观症状迅速改善。检测发现 IgA 型戊型肝炎病毒阳性，戊型肝炎的基因分析确定为基因型 1，这种基因型在日本并非地方性流行，因此明确诊断为从印度输入的戊型肝炎感染。类固醇治疗的成功反应表明，这种方法在治疗日本罕见的严重急性戊型肝炎病例中可能具有益处。本病例强调了在有近期旅行史前往戊型肝炎高发地区的个体中考虑戊型肝炎感染的重要性，以及类固醇治疗在管理严重急性戊型肝炎病例中的潜在益处。
