A significant number of cases of acute liver failure may be caused by the hepatitis E virus, which a new study suggests may not necessarily be identified or excluded using serologic tests.
A retrospective analysis of 80 European patients with acute liver failure or acute hepatitis found that, while 12 patients (15%) tested positive for hepatitis E virus (HEV) IgG antibodies, seven of these patients were negative for IgM antibodies or HEV RNA, according to a study published in Clinical Gastroenterology and Hepatology.
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Eight patients (10%) tested positive for HEV RNA, but only four of these were definitely positive for HEV IgG and five for HEV IgM.
Four were initially diagnosed as having idiosyncratic drug-induced liver injury, with other diagnoses being acetaminophen intoxication, amanita intoxication, and Wilson’s disease; one patient who had received a hematopoietic stem cell transplant was initially diagnosed with graft-versus-host disease.
One patient died, two received liver transplants, and the remaining patients survived (Clin Gastro Hepatol. 2015. doi: 10.1016/j.cgh.2015.04.014).
“Our data confirms recent descriptions of cases of severe liver injury in Europe, and underlines the necessity to consider hepatitis E as an underlying or additional cause for ALF [acute liver failure],” wrote Dr. Paul Manka of the University Duisburg-Essen in Essen, Germany, and coauthors.
The study was supported by the Deutsche Forschungsgemeinschaft (German Research Foundation) and by the Wilhelm-Laupitz Foundation. There were no other conflicts of interest declared.