A fatal case of exacerbated liver cirrhosis caused by acute hepatitis e virus infection: Atypical dynamics of anti-hepatitis e virus antibody titers

Abstract

A 72-year-old man was admitted to our hospital with complaints of general fatigue and abdominal swelling. Based on laboratory and imaging examinations, he was diagnosed with liver cirrhosis (complicated with hepatocellular carcinoma) and liver failure due to primary biliary cholangitis with positive anti-mitochondria M2 antibody and increased immunoglobulin M levels. Serum anti-hepatitis E virus (HEV) immunoglobulin A and HEV RNA were also positive, suggesting the diagnosis of acute-on-chronic hepatic exacerbation caused by HEV infection. After admission, although HEV RNA became undetectable, the patient died of rupture of hepatocellular carcinoma. During the observation period of 78 days, the titers of anti-HEV IgM, IgG, and IgA antibodies were relatively low and nearly unchanged. In cases of acute-on-chronic hepatitis, HEV infection should also be considered as a cause of hepatic exacerbation. Atypical dynamics of HEV antibodies observed in the present case warrants further examinations in HEV-infected patients with cirrhosis.