Premium
Extra‐hepatic manifestations of autochthonous hepatitis E infection
Author(s) -
Woolson K. L.,
Forbes A.,
Vine L.,
Bey L.,
McElhinney L.,
Panayi V.,
Hunter J. G.,
Madden R. G.,
Glasgow T.,
Kotecha A.,
Dalton H. C.,
Mihailescu L.,
Warshow U.,
Hussaini H. S.,
Palmer J.,
Mclean B. N.,
Haywood B.,
Bendall R. P.,
Dalton H. R.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12986
Subject(s) - medicine , hepatitis e , hepatitis e virus , lymphocytosis , hepatitis , gastroenterology , elevated transaminases , hepatitis a , peripheral neuropathy , pediatrics , biochemistry , chemistry , genotype , gene , diabetes mellitus , endocrinology
Summary Background Autochthonous (locally acquired) hepatitis E is increasingly recognised in developed countries, and is thought to be a porcine zoonosis. A range of extra‐hepatic manifestations of hepatitis E infection have been described, but have never been systematically studied. Aim To report the extra‐hepatic manifestations of hepatitis E virus. Methods Retrospective review of data of 106 cases of autochthonous hepatitis E (acute n = 105, chronic n = 1). Results Eight (7.5%) cases presented with neurological syndromes, which included brachial neuritis, Guillain‐Barré syndrome, peripheral neuropathy, neuromyopathy and vestibular neuritis. Patients with neurological syndromes were younger (median age 40 years, range 34–92 years, P = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, P = 0.015) compared to cases without neurological symptoms [median age 64 years (range 18–88 years), median ALT 1135 IU/L]. One patient presented with a cardiac arrhythmia,twelve patients (11.3%) presented with thrombocytopenia, fourteen (13.2%) with lymphocytosis and eight (7.5%) with a lymphopenia, none of which had any clinical consequence. Serum electrophoresis was performed in 65 patients at presentation, of whom 17 (26%) had a monoclonal gammopathy of uncertain significance. Two cases developed haematological malignancies, acute myeloid leukaemia and duodenal plasmacytoma, 18 and 36 months after presenting with acute hepatitis E infection. Conclusions A range of extra‐hepatic manifestations can occur with hepatitis E. Neurological and haematological features of hepatitis E infection are relatively frequent in this UK cohort, and result in significant morbidity which warrants further study.