Transfusion-acquired hepatitis E infection misdiagnosed as severe critical illness polyneuromyopathy in a heart transplant patient

Transpl Infect Dis. 2017 Dec;19(6). doi: 10.1111/tid.12784. Epub 2017 Nov 10.


This is the case of a 56-year-old man who underwent heart transplantation. Within the first postoperative days, his respiratory and limb muscles weakened, which was attributed to critical illness polyneuromyopathy (CIPM). At day 70 post transplantation, he had increased liver enzyme levels and acute hepatitis E virus (HEV) infection was diagnosed. HEV RNA was found in the serum, stools, and cerebrospinal fluid. Results of further investigations suggested a possible HEV-related polyradiculoneuropathy. At transplantation, the patient was negative for immunoglobulin (Ig)G, IgM, and HEV RNA. A trace-back procedure identified the source of infection and concluded that HEV infection was contracted from blood transfusion 12 days prior to transplantation from an HEV RNA-positive donor. Tests of the organ donor for HEV were negative. Phylogenetic analysis revealed sequence homology between the HEV-3 strain of the patient and the HEV-3 strain of the blood donor. Despite ribavirin treatment, the patient died on day 153 post transplantation from multiorgan failure. In conclusion, patients with hepatitis or neuropathic illness who have received blood products should be screened for HEV.

Keywords: HEV RNA screening; blood transfusion; heart recipient; hepatitis E; polyradiculoneuropathy.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / therapeutic use
  • Blood Transfusion*
  • Critical Illness
  • Diagnostic Errors
  • Fatal Outcome
  • Heart Transplantation / adverse effects*
  • Hepatitis E / diagnosis*
  • Hepatitis E / drug therapy
  • Hepatitis E / transmission
  • Hepatitis E / virology
  • Hepatitis E virus / genetics
  • Hepatitis E virus / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Multiple Organ Failure / virology
  • Muscular Diseases / diagnosis*
  • Polyneuropathies / diagnosis*
  • Polyradiculoneuropathy / diagnosis*
  • Polyradiculoneuropathy / drug therapy
  • Polyradiculoneuropathy / virology*
  • Postoperative Period
  • RNA, Viral / isolation & purification
  • Ribavirin / therapeutic use


  • Antiviral Agents
  • RNA, Viral
  • Ribavirin