Autochthonous hepatitis E as a cause of acute-on-chronic liver failure and death: histopathology can be misleading but transaminases may provide a clue

• DOI: 10.4414/smw.2021.20502
• Publication Date: 2021-05-17T20:10:27Z
• Authors: Joana Vieira Barbosa; Beat Müllhaupt; Felix Brunner; Magdalena Filipow...; David Semela; Matteo Montani; Gieri Cathomas; Jörg Neuweiler; Jérôme Gouttenoire; Florent Artru; Alexandre Louvet; Philippe Mathurin; Christine Sempoux; Daniela Lenggenhager; Achim Weber; Darius Moradpour; Montserrat Fraga
• Keywords: Alcoholic Hepatitis; Hepatitis E Virus; Histopathology; Liver function; Viral Hepatitis

Acute decompensation and death have been observed in patients with acute hepatitis E virus (HEV) infection preexisting liver cirrhosis. However, the clinical, laboratory histological features need to be fully characterised.Some of us recently described presentation a large panel tissue specimens. Here, we conducted case-control study investigate clinical subset HEV-related acute-on-chronic failure (ACLF) death. Each patient was matched three control histologically confirmed severe alcoholic based on sex, age, total bilirubin, INR, serum creatinine MELD score admission.Of 5 who died context ACLF, 3 (60%) were male median age 66 years (range 51–76). Median alanine aminotransferase (ALT) at 2610 U/l 705–3134) aspartate (AST) 2818 1176–8611). Liver function heavily altered all patients. Histological analyses revealed steatohepatitis background cirrhosis, suggestive an or nonalcoholic origin. Based histopathology, initially suspected two corticosteroid treatment initiated. Ribavirin started four time from hospitalisation 17 days 6–25 days). AST levels ACLF significantly higher as compared hepatitis.Typical histopathological viral may absent caused by HEV infection. should sought cirrhosis even absence changes suggesting