Transfusion-transmitted hepatitis E in a patient with myelodysplastic syndromes.

Abstract

Patients with haematological diseases occasionally exhibit liver dysfunction during treatment. This liver dysfunction can have various causes such as therapy-related drugs and hepatitis B and C infections, although the cause is unclear in some cases. It was recently reported that some patients initially diagnosed with drug-induced liver dysfunction actually had hepatitis E1. Several cases of transfusion-transmitted hepatitis E infections have also been reported1,2. In Japan, screening for hepatitis E does not appear to be performed at the initial examination of patients with acute hepatitis. This might be because hepatitis E is believed to be orally transmitted and to occur mainly in developing countries and rarely in developed countries. However, hepatitis E is a zoonotic infectious disease. Cases of regional endemic hepatitis E virus (HEV) infection have been increasing in Europe, the United States, and Japan1. Although HEV usually causes self-limited acute hepatitis, it sometimes progresses to a chronic infection. Most cases of chronic infection occur in patients undergoing solid organ or haematopoietic stem cell transplantation, in those receiving anti-cancer or immunosuppressant drugs, and in patients with human immunodeficiency virus infection, in whom the condition may progress to liver cirrhosis3. HEV RNA persisted for a long period during treatment in a patient with T-cell lymphoma4. Reactivation of HEV hepatitis was reported after an allogeneic haematopoietic stem cell transplant in a patient with Philadelphia chromosome-positive acute lymphoblastic leukaemia5. On the other hand, a low risk of HEV reactivation after haematopoietic stem cell transplantation was also reported6. More studies on the risk of HEV reactivation are, therefore, required. Here, we report the case of a patient with a myelodysplastic syndrome (MDS) who developed acute hepatitis due to transfusion-transmitted HEV infection. We also review the literature on the topic.