Extra-hepatic manifestations of autochthonous hepatitis E infection

Aliment Pharmacol Ther. 2014 Dec;40(11-12):1282-91. doi: 10.1111/apt.12986. Epub 2014 Oct 10.


Background: 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.

Aim: To report the extra-hepatic manifestations of hepatitis E virus.

Methods: Retrospective review of data of 106 cases of autochthonous hepatitis E (acute n = 105, chronic n = 1).

Results: 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, P = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, P = 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.

Conclusions: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • England / epidemiology
  • Female
  • Genotype
  • Hematologic Diseases / epidemiology*
  • Hepatitis E / epidemiology*
  • Hepatitis E / pathology*
  • Hepatitis E / physiopathology
  • Hepatitis E / psychology
  • Hepatitis E virus / genetics
  • Hepatitis E virus / pathogenicity
  • Humans
  • Male
  • Middle Aged
  • Molecular Sequence Data
  • Nervous System Diseases / epidemiology*
  • Retrospective Studies
  • Symptom Assessment / statistics & numerical data
  • Young Adult

Associated data

  • GENBANK/FN869554
  • GENBANK/FN869555
  • GENBANK/FN869556
  • GENBANK/KF513659
  • GENBANK/KF513741
  • GENBANK/KF513781
  • GENBANK/KF513902
  • GENBANK/KF514037
  • GENBANK/KF514075
  • GENBANK/KF514088
  • GENBANK/KF514089
  • GENBANK/KJ922011