Case Report: Chronic hepatitis E in a hematopoietic stem cell transplant recipient: The first report of hepatitis E virus genotype 4 causing chronic infection in a non-solid organ recipient

Zihao Chen; Junfeng Wei; Li Jiang; Dong Ying; Weikun Tian; Mengyang Zhang; Guiping Wen; Siling Wang; Chang Liu; Yingbin Wang; Ting Wu; Zimin Tang; Zizheng Zheng; Li Yan; Ningshao Xia

doi:10.3389/fimmu.2022.954697

Case Report: Chronic hepatitis E in a hematopoietic stem cell transplant recipient: The first report of hepatitis E virus genotype 4 causing chronic infection in a non-solid organ recipient

Front Immunol. 2022 Oct 5:13:954697. doi: 10.3389/fimmu.2022.954697. eCollection 2022.

Authors

Zihao Chen¹, Junfeng Wei², Li Jiang³, Dong Ying^{1

4}, Weikun Tian^{1

4}, Mengyang Zhang⁵, Guiping Wen⁶, Siling Wang¹, Chang Liu¹, Yingbin Wang^{1

7}, Ting Wu^{1

7}, Zimin Tang^{1

7}, Zizheng Zheng^{1

7}, Li Yan⁸, Ningshao Xia^{1

4

7

9}

Affiliations

¹ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, China.
² Department of Infectious Diseases, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Hematology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
⁴ School of Life Sciences, Xiamen University, Xiamen, China.
⁵ Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
⁶ United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, China.
⁷ Xiang An Biomedicine Laboratory, Xiamen University, Xiamen, China.
⁸ Department of Severe Hepatology, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China.
⁹ Research Unit of Frontier Technology of Structural Vaccinology, Chinese Academy of Medical Sciences, Xiamen, China.

Abstract

Hepatitis E virus (HEV) is one of the most important public health issues around the world, and chronic HEV infection has been reported in immunosuppressed individuals. This study reported a male case, with very severe aplastic anemia (AA), who developed chronic hepatitis E after hematopoietic stem cell transplantation (HSCT). Abnormal alanine aminotransferase (ALT) appeared after HSCT and persisted for twenty-nine months. The case was seropositive for anti-HEV IgG and IgM after HSCT. Twenty-two months after HSCT, HEV RNA and antigen (Ag) testing were positive and persisted for five and seven months, respectively. Positive stains of HEV Ag were present in a liver biopsy sample. HEV Ag was present in bone marrow. The individual rapidly developed liver cirrhosis and was rescued by a regimen of oral ribavirin. These factors suggested there is a risk of HEV infection in HSCT recipients.

Keywords: aplastic anemia; chronic hepatitis; cirrhosis; hematopoietic stem cells transplantation; hepatitis E virus.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Alanine Transaminase
Genotype
Hematopoietic Stem Cell Transplantation* / adverse effects
Hepatitis E virus* / genetics
Hepatitis E* / diagnosis
Hepatitis E* / drug therapy
Humans
Immunoglobulin G / genetics
Immunoglobulin M / genetics
Male
Persistent Infection
RNA
Ribavirin / therapeutic use

Substances

Ribavirin
Alanine Transaminase
Immunoglobulin G
Immunoglobulin M
RNA