Acute Hepatitis E by a New Isolate Acquired in the United States

doi:10.4065/72.12.1133

Mayo Clinic Proceedings

Volume 72, Issue 12, December 1997, Pages 1133-1136

https://doi.org/10.4065/72.12.1133 Get rights and content

Objective

To report the first case of acute hepatitis E by a novel isolate acquired in the United Statesand confirmed by nucleotide sequencing.

Materia and Methods:

We describe the clinical manifestations and the results of associated labora-tory studies in a man who was found to have acute hepatitis E infection.

Results

A 62-year-old man was hospitalized because of fever, abdominal pain, and jaundice. After an initial evaluation did not provide a cause, his serum was found to be positive for IgG anti-hepatitis Evirus (HEV) by three antibody assays. Serum was also positive for HEV RNA by reverse transcriptase polymerase chain reaction (PCR). Sequencing resultsfrom the PCR products demonstrated substantial differences at the nucleotide level between this strain andthe known Mexican and Burmese strains.

Conclusion

On the basis of this initial report, HEV should be considered an etiologie agent in patients with acute non-ABC hepatitis in the United States.

Section snippets

REPORT OF CASE

A 62-year-old white man was hospitalized in Rochester, Minnesota, after a 3-week history of fever, abdominal pain, jaundice, and pruritus. He had had the onset of these signs and symptoms 2 weeks after returning home from a 10-day trip to San Jose, California, on Mar. 21, 1995. Past medical history included a nephrectomy for autosomal dominant polycystic kidney disease in conjunction with mild renal insufficiency, a laparoscopic cholecystectomy for symptomatic cholelithiasis, hypertension for

DISCUSSION

The pathologic findings in the liver biopsy specimen from this patient are consistent with acute hepatitis E. The “standard” or “classic” type of lobular hepatitis found in this patient has been noted in approximately 45% of patients with hepatitis E in outbreak settings.¹ Previous cases of lisinopril related hepatitis have occurred weeks after administration of this drug and have been associated with centrilobular necrosis and positive autoimmune markers, which were not present in this case.¹⁰

CONCLUSION

Hepatitis A remains the most common cause of viral hepatitis among US residents traveling abroad, although HEV infection should be considered in any person coming from an HEV endemic area with hepatitis and negative serologic markers for hepatitis A, B, and C. In addition, on the basis of this report, HEV should now be considered as an etiologie agent in persons with acute non-ABC hepatitis in the United States.

ACKNOWLEDGMENT

The assistance of Karen Coy and Matthew Smith (Santa Clara, California, Health Department), Carol Glaser (California Department of Health Services), and Lynne Akinroluyu (Minnesota Department of Health) with the epidemiologic investigation was sincerely appreciated, as was the superb technical assistance of Gretchen Gabriel (Abbott Laboratories) and Karen McCaustland (Centers for Disease Control and Prevention). Drs. John W. Bachman and John E. King (Mayo Clinic Rochester) provided excellent

REFERENCES (17)

GJ Dawson et al.
Detection of long-lasting antibody to hepatitis E virus in a US traveller to Pakistan [letter]
Lancet
(1992)
GJ Dawson et al.
Solid-phase enzyme-linked immunosorbent assay for hepatitis E virus IgG and IgM antibodies utilizing recombinant antigens and synthetic peptides
J Virol Methods
(1992)
CC Huang et al.
Molecular cloning and sequencing of the Mexico isolate of hepatitis E virus (HEV)
Virology
(1992)
GG Schlauder et al.
Viraemia in Egyptian children with hepatitis E virus infection [letter]
Lancet
(1993)
D Larrey et al.
Fulminant hepatitis after lisinopril administration
Gastroenterology
(1990)
MA Purdy et al.
Hepatitis E
Gastroenterol Clin North Am
(1994 Sep)
MJ Alter et al.
The epidemiology of viral hepatitis in the United States
Gastroenterol Clin North Am
(1994 Sep)
K Krawczynski
Hepatitis E
Hepatology
(1993)

There are more references available in the full text version of this article.

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Mayo Clinic ProceedingsAcute Hepatitis E by a New Isolate Acquired in the United States

Objective

Materia and Methods:

Results

Conclusion

Section snippets

REPORT OF CASE

DISCUSSION

CONCLUSION

ACKNOWLEDGMENT

Lancet

J Virol Methods

Virology

Lancet

Gastroenterology

Gastroenterol Clin North Am

Gastroenterol Clin North Am

Hepatitis E

Hepatology

Mayo Clinic Proceedings
Acute Hepatitis E by a New Isolate Acquired in the United States