A case of acute hepatitis E with negative serum immunoglobulin A-hepatitis E virus antibody in the early stage of the disease onset

Abstract

OntheX-12th day, a man in his 60s became aware of itching throughout his body. Thus, he visited a dermatologist on the X-10th day and was prescribed epinastine hydrochloride and diflucortolone valerate cream. Further, on the X-8th day, he visited an internal medicine clinic, and the following findings were noted: aspartate aminotransferase level, 217 U/L; alanine transaminase level, 400 U/L; and immunoglobulin A-hepatitis E virus antibody (IgA-HEV antibody) negative. On the X-1st day, he visited the clinic again, and liver damage exacerbation was confirmed. Furthermore, on the X day, he was referred to our hospital. At the time of admission, IgA-HEV antibody was not tested; however, on the X＋7th day, it was found to be positive. Although the examination of the conserved serum revealed that the IgG-HEV antibody, IgM-HEV antibody, IgA-HEV antibody, and HEV-RNA were negative, negative, negative, and positive (subgenotype 4c), respectively, all of them were positive on the X＋2nd day. In rare cases, IgA-HEV antibody may remain negative in the early stage of acute hepatitis E. Thus, IgA-HEV antibody retesting and HEV-RNA testing should be performed if no other condition is suspected and the patient presents with a history of consuming a particular diet, such as meat.