Autochthonous hepatitis E in a patient from Zagreb: a case report

Abstract

Hepatits E virus (HEV) je globalni patogen koji uzrokuje epidemijske i sporadične slučajeve akutnog hepatitisa u Aziji i Africi. Sporadični slučajevi bilježe se i u Europi, većinom u putnika iz endemskih zemalja. U studenom 2012. godine zaprimljen je bolesnik u dobi 62 godine zbog sumnje na bakterijsku pneumoniju. Bolest je započela dva tjedna pred prijam febrilitetom i respiratornim simptomima koji su regredirali tijekom ambulantnog liječenja cefuroksim-aksetilom. Šesti dan liječenja zbog pojave osipa bolesnik je hospitaliziran. Bolesnik je kod prijma bio ikteričan, s eritematoznim makuloznim osipom. Laboratorijskom obradom nađene su umjereno povišene vrijednosti upalnih parametara uz hiperbilirubinemiju i povišene vrijednosti transaminaza. Na sumacijskoj snimci torakalnih organa viđen je opsežan intersticijski infiltrat u desnom gornjem režnju pluća. Serološkim i molekularnim testovima dokazana je akutna infekcija HEV-om. Serološka dijagnostika za uzročnike atipične pneumonije ukazivala je na moguću istovremenu infekciju s C. pneumoniae. Simptomatskim liječenjem postignuto je izlječenje uz normalizaciju svih laboratorijskih nalaza nakon tri mjeseca praćenja, bez razvoja komplikacija. Ovim radom prikazali smo bolesnika iz Zagreba s ikteričnim oblikom akutnog hepatitisa E koji nije boravio izvan Hrvatske što je prema dostupnoj literaturi prvi opisani slučaj autohtonog hepatitisa E u Hrvatskoj. Bolesnik je tijekom bolesti razvio osip i pneumonični infiltrat koji se etiološki nisu mogli jasno definirati. Bolesnike s kliničkom slikom akutnog virusnog hepatitisa koji nije uzrokovan virusima hepatitis A, B ili C te EBV-om i CMV-om trebalo bi testirati i na HEV.Hepatitis E virus (HEV) is a global pathogen that causes epidemic and sporadic cases of acute hepatitis in Asia and Africa. However, recently, sporadic cases have been recorded in European countries as well. In November 2012, a 62-year-old patient was admitted with suspicion of bacterial pneumonia. The disease started two weeks prior to admission with fever and respiratory symptoms. The regression of symptoms was noted during outpatient treatment with cefuroxime-axetil. On the sixth day of treatment a rash appeared and the patient was admitted to our hospital. On admission, he was icteric, with an erythematous macular rash on the trunk. Laboratory tests found moderately elevated inflammatory parameters with hyperbilirubinemia and elevated liver enzymes. On chest X-ray extensive interstitial pulmonary infiltration was recorded. Serological and molecular diagnostics confirmed acute HEV-infection. Serological diagnostics on microorganisms of atypical pneumonia suggested possible simultaneous C. pneumoniae infection. Symptomatic treatment achieved a complete cure with normalization of laboratory tests after three months follow-up, without any complications. In this paper, we presented a case of an icteric form of acute hepatitis E in a patient from Zagreb who didn\u27 travel abroad, therefore according to avaliable literature, this is the first described case of autochthotonous hepatitis E in Croatia. During the course of the disease the patient developed a rash and pneumonic infiltration the etiology of which could not be clearly defined. In patients with clinical feature of acute viral hepatitis after exclusion of hepatitis A, B, C and EBV and CMV infections, diagnostic on HEV should be conducted