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Transfusion‐acquired hepatitis E infection misdiagnosed as severe critical illness polyneuromyopathy in a heart transplant patient
Author(s) -
Belliere Julie,
Abravanel Florence,
Nogier Marie Béatrice,
Martinez Salima,
Cintas Pascal,
Lhomme Sébastien,
Lavayssière Laurence,
Cointault Olivier,
Faguer Stanislas,
Izopet Jacques,
Kamar Nassim
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12784
Subject(s) - medicine , heart transplantation , ribavirin , transplantation , liver transplantation , blood transfusion , hepatitis e virus , hepatitis e , virology , hepatitis c virus , virus , genotype , biochemistry , chemistry , gene
This is the case of a 56‐year‐old man who underwent heart transplantation. Within the first postoperative days, his respiratory and limb muscles weakened, which was attributed to critical illness polyneuromyopathy ( CIPM ). At day 70 post transplantation, he had increased liver enzyme levels and acute hepatitis E virus ( HEV ) infection was diagnosed. HEV RNA was found in the serum, stools, and cerebrospinal fluid. Results of further investigations suggested a possible HEV ‐related polyradiculoneuropathy. At transplantation, the patient was negative for immunoglobulin (Ig)G, IgM, and HEV RNA . A trace‐back procedure identified the source of infection and concluded that HEV infection was contracted from blood transfusion 12 days prior to transplantation from an HEV RNA ‐positive donor. Tests of the organ donor for HEV were negative. Phylogenetic analysis revealed sequence homology between the HEV ‐3 strain of the patient and the HEV ‐3 strain of the blood donor. Despite ribavirin treatment, the patient died on day 153 post transplantation from multiorgan failure. In conclusion, patients with hepatitis or neuropathic illness who have received blood products should be screened for HEV .