Extra-hepatic manifestations of autochthonous hepatitis E infection

BackgroundAutochthonous (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. AimTo report the extra-hepatic manifestations of hepatitis E virus. MethodsRetrospective review of data of 106 cases of autochthonous hepatitis E (acute n=105, chronic n=1). ResultsEight (7.5%) cases presented with neurological syndromes, which included brachial neuritis, Guillain-Barre syndrome, peripheral neuropathy, neuromyopathy and vestibular neuritis. Patients with neurological syndromes were younger (median age 40years, range 34-92years, P=0.048) and had a more modest transaminitis (median ALT 471IU/L, P=0.015) compared to cases without neurological symptoms [median age 64years (range 18-88years), median ALT 1135IU/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 36months after presenting with acute hepatitis E infection. ConclusionsA 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.