An Acute Infection due to Hepatitis E in the Context of a Patient with Rituximab and Methotrexate Therapy

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. The patient arrived at the Emergency Department with epigastric pain,...

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Published inEuropean journal of case reports in internal medicine Vol. 11; no. 4; p. 004378
Main Authors Cordero Pérez, Francisco Josué, Martín-Garrido, Eva P, Antona-Herranz, Marta, Bailador-Andrés, Carmen, Conde-Gacho, Pilar, de Diego-Cobos, Clara, Rodriguez-Gomez, Santiago J
Format Journal Article
LanguageEnglish
Published Italy SMC MEDIA SRL 2024
Subjects
antisynthetase syndrome
hepatitis e
methotrexate
rituximab
hepatitis E
methotrexate
Antisynthetase syndrome
rituximab
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Summary: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. 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. 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. Suspect hepatitis E virus infection in the presence of persistent liver failure of unknown cause.Recognise immunosuppression as a cause of increased risk of hepatitis E infection.Take into account the repercussions of immunosuppressive therapy such as rituximab regarding hepatitis E infections in immunocompromised patients.
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ISSN:2284-2594
2284-2594
DOI:10.12890/2024_004378