Infection in Heart-Lung Transplant Patient, France

In March 2022, a 61-year-old woman in France who had received a heart-lung transplant sought treatment with chronic hepatitis mainly characterized by increased liver enzymes. After ruling out common etiologies, we used metagenomic next-generation sequencing to analyze a liver biopsy sample and identified an unknown spe-cies of circovirus, tentatively named human circovirus 1 (HCirV-1). We found no other viral or bacterial sequenc-es. HCirV-1 shared 70% amino acid identity with the closest known viral sequences. The viral genome was undetectable in blood samples from 2017-2019, then became detectable at low levels in September 2020 and peaked at very high titers (1010 genome copies/mL) in January 2022. In March 2022, we found > 108 genome copies/g or mL in the liver and blood, concomitant with hepatic cytolysis. We detected HCirV-1 transcripts in 2% of hepatocytes, demonstrating viral replication and supporting the role of HCirV-1 in liver damage.

Automated summary

In March 2022, a 61-year-old woman in France who had received a heart-lung transplant was diagnosed with chronic hepatitis characterized by increased liver enzymes. Metagenomic next-generation sequencing revealed the presence of an unknown circovirus, named human circovirus 1 (HCirV-1), in a liver biopsy sample. The viral genome was undetectable in blood samples from 2017-2019, but became detectable in September 2020 and reached high titers in January 2022, concurrent with liver damage indicated by elevated liver enzyme levels and high viral copies in the liver and blood.