An acute infection due to hepatitis E in the context of a patient with rituximab and methotrexate therapy
  • Francisco Josué Cordero Pérez
    Servicio de Medicina Interna, Complejo Asistencial de Zamora, Zamora, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
  • Eva P. Martín Garrido
    Servicio de Aparato Digestivo, Complejo Asistencial de Zamora, Zamora, Spain
  • Marta Antona-Herranz
    Servicio de Aparato Digestivo, Complejo Asistencial de Zamora, Zamora, Spain
  • Carmen Bailador-Andrés
    Servicio de Aparato Digestivo, Complejo Asistencial de Zamora, Zamora, Spain
  • Pilar Conde-Gacho
    Servicio de Aparato Digestivo, Complejo Asistencial de Zamora, Zamora, Spain
  • Clara de Diego-Cobos
    Servicio de Medicina Interna, Complejo Asistencial de Zamora, Zamora, Spain
  • Santiago J. Rodriguez-Gomez
    Servicio de Aparato Digestivo, Complejo Asistencial de Zamora, Zamora, Spain

Keywords

Antisynthetase syndrome, hepatitis E, methotrexate, rituximab

Abstract

Background: This report presents the influence of immunosuppression by new rheumatological therapies on hepatitis E virus infection in a 54-year-old male patient with an anti-synthetase syndrome and treatment with methotrexate and rituximab.
Case description: The patient arrived at the Emergency Department with epigastric pain, vomiting and dark urine. Initial examination revealed signs of inflammation and hepatic dysfunction. Subsequent laboratory tests and imaging confirmed acute hepatitis E infection in the context of recent initiation of rituximab therapy. Despite initial suspicion of pancreatitis, subsequent investigations ruled out pancreatic involvement. Treatment with ribavirin, along with supportive measures, led to significant clinical improvement with resolution of jaundice, ascites, and oedema.
Conclusions: This case underscores the importance of considering hepatitis E in patients with autoimmune conditions, especially when initiating immunosuppressive therapies, a situation that is not well described in scientific literature and is increasingly common, necessitating proper recognition.

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References

  • Gunsar F. Hepatitis E update. Hepatol Forum 2020;1:37–40.
  • Yadav KK, Kenney SP. Hepatitis E virus immunopathogenesis. Pathogens 2021;10:1180.
  • Lhomme S, Marion O, Abravanel F, Chapuy-Regaud S, Kamar N, Izopet J. Hepatitis E pathogenesis. Viruses 2016;8:212.
  • LeDesma R, Nimgaonkar I, Ploss A. Hepatitis e virus replication. Viruses 2019;11:719.
  • Riveiro-Barciela M, Rodríguez-Frías F, Buti M. Hepatitis E: Dimensión del problema en España. Gastroenterol Hepatol 2012;35:719–724.
  • Portal estadístico del Ministerio de Sanidad, Nodo de información CMBD [consultado 7 Feb 2024]. Disponible en: http://pestadistico.inteligenciadegestion.msssi.es/publicoSNS/comun/DefaultPublico.aspx http://www.msssi.gob.es/estadEstudios/estadisticas/docs/ Spanish.
  • Dalton B, Cunnane G, Conway R. Acute hepatitis E in an immunocompromised patient with seropositive rheumatoid arthritis on rituximab and long-term methotrexate. Mod Rheumatol Case Rep 2021;5:226–228.
  • Ollier L, Tieulie N, Sanderson F, Heudier P, Giordanengo V, Fuzibet J-G, et al. Chronic hepatitis after hepatitis E virus infection in a patient with non-Hodgkin lymphoma taking rituximab. Ann Intern Med 2009;150:430–431.
  • Aslan AT, Balaban HY. Hepatitis E virus: epidemiology, diagnosis, clinical manifestations, and treatment. World J Gastroenterol 2020;26:5543–5560.
  • Kenneth E Sherman. Hepatitis E virus infection. In: UpToDate, Adrian M Di Bisceglie (Ed), UpToDate, Waltham, MA. (Accessed 7 February 2024).
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    Published: 2024-03-01
    Issue: 2024: Vol 11 No 4 (view)


    How to cite:
    1.
    Cordero Pérez FJ, Martín Garrido EP, Antona-Herranz M, Bailador-Andrés C, Conde-Gacho P, de Diego-Cobos C, Rodriguez-Gomez SJ. An acute infection due to hepatitis E in the context of a patient with rituximab and methotrexate therapy. EJCRIM 2024;11 doi:10.12890/2024_004378.