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Case Reports
. 2018 Jun 10:2018:bcr2017223616.
doi: 10.1136/bcr-2017-223616.

Acute hepatitis E superinfection leading to chronic hepatitis B reactivation

Aysha Aslam  1 , Ammu Susheela  1 , Sentia Iriana  1 , Suzanne S Chan  1 , Daryl Lau  1
Affiliations
Case Reports

Acute hepatitis E superinfection leading to chronic hepatitis B reactivation

Aysha Aslam et al. BMJ Case Rep. .

Abstract

Reactivation of chronic hepatitis B (CHB) can be associated with significant morbidity and mortality. There are many different causes of hepatitis B reactivation. This case describes an Asian woman with stable CHB presenting with significant hepatitis flare with markedly elevated serum aminotransferases and hepatitis B virus DNA level. The clinical symptoms were subtle with fatigue and vague right upper quadrant tenderness. We ruled out drug-associated hepatotoxicity and screened for common causes of acute hepatitis. Interestingly, she was noted to have reactive anti-hepatitis E virus (HEV) IgM at initial presentation followed by anti-HEV IgG positivity a month later. The serological pattern confirmed the diagnosis of acute hepatitis E. The combination of antiviral therapy for hepatitis B and resolution of acute hepatitis E resulted in normalisation of serum aminotransferases. This case illustrates the importance of taking a careful history and having a high index of suspicion for various aetiologies when evaluating patients with reactivation of CHB.

Keywords: foodborne infections; hepatitis B; hepatitis other.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Time course of ALT and hepatitis B virus (HBV) DNA level before, during and after acute hepatitis E virus (HEV) superinfection.
See this image and copyright information in PMC

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