Hirano Rei, Kanda Tatsuo, Honda Masayuki, Arima Shuhei, Totsuka Mai, Masuzaki Ryota, Kanezawa Shini, Sasaki-Tanaka Reina, Matsumoto Naoki, Yamagami Hiroaki, Ishii Tomotaka, Ogawa Masahiro, Nomura Shuzo, Fujisawa Mariko, Saito Kei, Takahashi Masaharu, Okamoto Hiroaki, Kogure Hirofumi
Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan.
Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Reports (MDPI). 2023 Nov 17;6(4):55. doi: 10.3390/reports6040055.
Hepatitis E virus (HEV) genotypes 3 and 4 are zoonotic strains that are primarily transmitted through the consumption of undercooked pork or game meat. They also cause asymptomatic infections, acute hepatitis, acute-on-chronic liver failure, chronic hepatitis, and extrahepatic manifestations. Here, we report a man in his 80s who had chronic hepatitis B, took entecavir for it, and presented with higher levels of alanine aminotransferase (ALT) and jaundice. An abdominal computed tomography scan revealed choledocholithiasis with cholecystolithiasis. Although endoscopic papillary balloon dilatation was performed for the removal of a common bile duct stone, the abnormal liver function tests, including jaundice, were prolonged. After other viral hepatitis and other causes of the liver injury were ruled out, as his serum was positive for immunoglobulin A anti-HEV and HEV genotype 3b RNA, we diagnosed him as having acute hepatitis E. In this case, with chronic hepatitis B and a common bile duct stone, the prolonged abnormal results for the liver function tests seemed to be caused by HEV infection. In conclusion, in cases with high ALT levels after removing choledocholithiasis, other factors, including HEV infection, should be considered to determine the cause of abnormal liver function test results. The further examination of hepatitis D virus infection and high ALT levels may be needed in HBV-infected individuals.
戊型肝炎病毒（HEV）基因型3和4是人畜共患毒株，主要通过食用未煮熟的猪肉或野味传播。它们还会引起无症状感染、急性肝炎、慢加急性肝衰竭、慢性肝炎和肝外表现。在此，我们报告一名80多岁的男性，他患有慢性乙型肝炎，服用恩替卡韦治疗，出现丙氨酸转氨酶（ALT）水平升高和黄疸。腹部计算机断层扫描显示胆总管结石伴胆囊结石。尽管为取出胆总管结石进行了内镜乳头球囊扩张术，但包括黄疸在内的肝功能检查异常仍持续存在。在排除其他病毒性肝炎和其他肝损伤原因后，由于其血清中免疫球蛋白A抗-HEV和HEV基因型3b RNA呈阳性，我们诊断他为急性戊型肝炎。在这种情况下，由于患有慢性乙型肝炎和胆总管结石，肝功能检查异常持续存在似乎是由HEV感染引起的。总之，在胆总管结石取出术后ALT水平升高的病例中，应考虑包括HEV感染在内的其他因素，以确定肝功能检查结果异常的原因。对于HBV感染个体，可能需要进一步检查丁型肝炎病毒感染和高ALT水平。
