Extra‐hepatic manifestations of autochthonous hepatitis E infection. Issue 11 (10th October 2014)

• Record Type: Journal Article
• Authors: Woolson, K. L.; Forbes, A.; Vine, L.; Beynon, 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.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 40:Issue 11/12(2014)
• Page Start: 1282
• Page End: 1291
• Publication Date: 2014-10-10
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12986
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12986-abs-0001"> <title>Summary</title> <sec id="apt12986-sec-0001" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="apt12986-sec-0002" sec-type="section"> <title>Aim</title> <p>To report the extra‐hepatic manifestations of hepatitis E virus.</p> </sec> <sec id="apt12986-sec-0003" sec-type="section"> <title>Methods</title> <p>Retrospective review of data of 106 cases of autochthonous hepatitis E (acute <italic>n</italic> = 105, chronic <italic>n</italic> = 1).</p> </sec> <sec id="apt12986-sec-0004" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, <italic>P </italic>= 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.</p> </sec> <sec id="apt12986-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>