Chronic Hepatitis E Virus Infection: A Red Flag for Undiagnosed Hematological Malignancy?

Abstract

Hepatitis E virus (HEV) is known to be able to establish chronic infection in a subset of patients who are immunosuppressed. We present a case of a patient who was initially diagnosed with a chronic HEV infection which subsequently revealed a hematological malignancy. We believe this to be the first case in which the finding of chronic HEV infection has led directly to the finding of an underlying cause of immune compromise. A 66-year-old female of Northern European origin presented to gastroenterology with right upper quadrant pain and weight loss. The cause was initially unclear despite investigations. The following year she was diagnosed with chronic HEV infection. As chronic HEV is not recognized in patients without underlying immune compromise, she was thoroughly investigated for a cause and was found to have extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue type. HEV was successfully eradicated using ribavirin. Combination chemotherapy was given for lymphoma and she made a good recovery, with resolution of her previous gastrointestinal symptoms. This reinforces the understanding that chronic HEV infection does not occur in immunocompetent patients and that a finding of chronic HEV infection in a patient without a pre-existing reason for immune compromise should be followed with a thorough search for the underlying cause.




Clin Infect Immun. 2020;5(2):45-48
doi: https://doi.org/10.14740/cii108