Volume 100, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Hepatitis E virus (HEV) is globally the most common cause of acute viral hepatitis. In industrialized countries, HEV infection can be seen in travelers returning from hyperendemic countries or in individuals at risk for autochthonous infection due to zoonotic exposure. Hepatitis E virus infection is often unrecognized and at times misdiagnosed because of nonspecific findings that can overlap with other causes of hepatitis, including autoimmune hepatitis (AIH). Although most cases of acute HEV infection resolve spontaneously and do not require treatment, life-threatening acute liver failure may occur in some cases. We discuss the case of an 8-year-old boy returning from Bangladesh with progressive acute liver injury and a clinical profile suggestive of AIH, who showed a favorable response to corticosteroid treatment before the diagnosis of an acute HEV infection could be established.


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  1. Khuroo MS, Khuroo MS, Khuroo NS, , 2016. Hepatitis E: discovery, global impact, control and cure. World J Gastroenterol 22: 70307045. [Google Scholar]
  2. Kamar N, Izopet J, Pavio N, Aggrawal R, Labrique A, Wedemeyer H, Dalton HR, , 2017. Hepatitis E virus infection. Nat Rev Dis Primers 3: 17086. [Google Scholar]
  3. Ali G, Kumar M, Bali S, Wadhwa W, , 2001. Hepatitis E associated immune thrombocytopaenia and membranous glomerulonephritis. Indian J Nephrol 11: 7072. [Google Scholar]
  4. Pischke S, Hartl J, Pas SD, Lohse AW, Jacobs BC, Van der Eijk AA, , 2017. Hepatitis E virus: infection beyond the liver? J Hepatol 66: 10821095. [Google Scholar]
  5. Dahl V, Wallenstein A, , 2017. Self-reported infectious during international travel and notifiable infections among returning international travellers, Sweden, 2009–2013. PLoS One 12: e0181625. [Google Scholar]
  6. Patel I, Ching Companioni R, Bansal R, Vyas N, Catalano C, Aron J, Walfish A, , 2016. Acute hepatitis E presenting with clinical feature of autoimmune hepatitis. J Community Hosp Intern Med Perspect 6: 33342. [Google Scholar]
  7. Sebode M, Pischke S, Lütgehetmann M, Polywka S, Quaas A, Lohse AW, Wege H, , 2014. New foe treated with old guns—supportive role of steroids in the treatment of acute severe hepatitis E. BMC Gastroenterol 14: 191. [Google Scholar]
  8. Ebbeson RL, Schruiber RA, , 2004. Diagnosing autoimmune hepatitis in children: is the international autoimmune hepatitis group scoring system useful? Clin Gastroenterol Hepatol 2: 935940. [Google Scholar]
  9. Alvarez F, 1999. International autoimmune hepatitis group: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 31: 929938. [Google Scholar]
  10. Hiejima E, Komatsu H, Sogo T, Inui A, Fujisawa T, , 2011. Utility of simplified criteria for the diagnosis of autoimmune hepatitis in children. J Pediatr Gastroenterol Nutr 52: 470473. [Google Scholar]
  11. Sugitani M, 2009. Detection of hepatitis E virus RNA and genotype in Bangladesh. J Gastroenterol Hepatol 24: 599604. [Google Scholar]
  12. Zuckerman JN, , 2003. Hepatitis E and the traveller. Travel Med Infect Dis 1: 7376. [Google Scholar]
  13. Leder K, 2013. GeoSentinel surveillance of illness in returned travelers, 2007–2011. Ann Intern Med 158: 456468. [Google Scholar]
  14. Heywood AE, 2016. The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance. Epidemiol Infect 144: 35543563. [Google Scholar]
  15. Bradanini L, Youkee D, Fabris P, Roman L, Brunetti E, Giordani MT, , 2017. Acute hepatitis E virus infection in a migrant population in north east Italy: a retrospective analysis. Travel Med Infect Dis 20: 3742. [Google Scholar]
  16. Azman AS, 2017. High hepatitis E seroprevalence among displaced persons in South Sudan. Am J Trop Med Hyg 96: 12961301. [Google Scholar]
  17. Sadarangani SP, Lim PL, Vasoo S, , 2017. Infectious diseases and migrant worker health in Singapore: a receiving country’s perspective. J Travel Med 24: tax014. [Google Scholar]
  18. Eick A, 2010. Hepatitis E seroprevalence and seroconversion among US military service members deployed to Afghanistan. J Infect Dis 202: 13021308. [Google Scholar]
  19. Teshale EH, Brunette GW, Kozarsky PE, , 2017. Hepatitis E. , eds. CDC Health Information for International Travel 2018. New York, NY: Oxford University Press. [Google Scholar]
  20. Mieli-Vergani G, 2009. Autoimmune hepatitis. J Pediatr Gastroenterol Nutr 49: 158164. [Google Scholar]
  21. Arcos-Machancoses JV, Molera Busoms C, Julio Tatis E, Victoria Bovo M, Quintero Bernabeu J, Juamperez Goni J, Crujeiras Martinez V, Martin de Carpi J, , 2018. Accuracy of the 2008 simplified criteria for the diagnosis of autoimmune hepatitis in children. Pediatr Gastroenterol Hepatol Nutr 21: 118126. [Google Scholar]
  22. Vergani D, Choudhuri K, Bogdanos DP, Mieli-Vergani G, , 2002. Pathogenesis of autoimmune hepatitis. Clin Liver Dis 6: 727737. [Google Scholar]
  23. Pischke S, 2014. Increased HEV seroprevalence in patients with autoimmune hepatitis. PLoS One 9: e85330. [Google Scholar]
  24. Van Gerven NM, van der Eijk AA, Pas SD, Zaaijer HL, de Boer YS, Witte BI, van Nieuwkerk CM, Mulder CJ, Bouma G, de Man RA, , 2016. Seroprevalence of hepatitis E virus in autoimmune hepatitis patients in The Netherlands. J Gastrointestin Liver Dis 25: 913. [Google Scholar]
  25. Vieira CL, Baldaia C, Fatela N, Ramalho F, Cardoso C, , 2013. Case of acute hepatitis E with concomitant signs of autoimmunity. World J Hepatol 5: 152155. [Google Scholar]
  26. Le Cann P, Tong MJ, Werneke J, Coursaget P, , 1997. Detection of antibodies to hepatitis E virus in patients with autoimmune chronic active hepatitis and primary biliary cirrhosis. Scand J Gastroenterol 32: 387389. [Google Scholar]
  27. Cook GC, Mulligan R, Sherlock S, , 1971. Controlled prospective trial of corticosteroid therapy in active chronic hepatitis. Q J Med 40: 159185. [Google Scholar]
  28. Wedemeyer H, Rybczynska J, Pischke S, Krawczynski K, , 2013. Immunopathogenesis of hepatitis E virus infection. Semin Liver Dis 33: 7178. [Google Scholar]
  29. Nagasaki F, Ueno Y, Mano Y, Igarashi T, Yahagi K, Niitsuma H, Okamoto H, Shimosegawa T, , 2005. A patient with clinical features of acute hepatitis E viral infection and autoimmune hepatitis. Tohoku J Exp Med 206: 173179. [Google Scholar]
  30. Verghese VP, Robinson JL, , 2014. A systematic review of hepatitis E virus infection in children. Clin Infect Dis 59: 689697. [Google Scholar]
  31. Ramachandran J, Ramakrishna B, Eapen CE, Abraham P, Zachariah UG, Jayram A, Mathews M, Kurian G, Mukopadhya A, Chandy G, , 2008. Subacute hepatic failure due to hepatitis E. J Gastroenterol Hepatol 23: 879882. [Google Scholar]

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  • Received : 03 Aug 2018
  • Accepted : 16 Sep 2018
  • Published online : 22 Oct 2018

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