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14 July 2019 : Case report  Uruguay

Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient

Unusual clinical course, Challenging differential diagnosis

Victoria Mainardi1BCDEF, Solange Gerona1CD, Gonzalo Ardao1BCD, Noelia Ferreira1CD, Gabriel Ramírez2CD, Juan Arbiza2EF, Santiago Mirazo2ADEF*

DOI: 10.12659/AJCR.916253

Am J Case Rep 2019; 20:1016-1021

Abstract

BACKGROUND: Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing regions. In high-income countries, hepatitis E is an emergent zoonotic disease of increasing concern. Clinically, the infection is usually acute and self-limited in immunocompetent individuals, although rare chronic cases in immunocompromised patients have been reported. Both acute and chronic infections have been recently associated with several extrahepatic manifestations, including neurological and hematological disorders.

CASE REPORT: A case of autochthonous chronic HEV infection in a liver-transplanted man from a non-endemic country is presented. Phylogenetic analysis revealed a swine origin of the HEV human infection. Chronic hepatitis E was treated with a 9-week course of ribavirin, after which viral clearance was achieved. Subsequently, the patient developed a post-transplant lymphoproliferative disorder (PTLD) in the form of Burkitt lymphoma. At the time of lymphoma diagnosis, the patient had shown a strong reactivation of Epstein-Barr virus (EBV) infection. After additional antiviral ganciclovir therapy and chemotherapy, the patient had a complete recovery with no sequelae.

CONCLUSIONS: The differential diagnosis of persistently elevated transaminases in transplanted and/or immunocompromised patients should include testing for HEV by appropriate nucleic acid techniques (NATs). Cases of HEV infection with an atypical clinical outcome, such as the one presented herein, highlights the need for increased awareness of chronic hepatitis E and its association with a wide range of extrahepatic manifestations.

Keywords: Hepatitis, Chronic, Liver Transplantation, Lymphoproliferative Disorders, Epstein-Barr virus infection, Burkitt Lymphoma, Epstein-Barr Virus Infections, Hepatitis E, Immunocompromised Host, Middle Aged

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923