Liver transplantation for acute liver failure related to autochthonous genotype 3 hepatitis E virus infection.

Hepatitis E virus of genotype 3 (HEV-3) is an emerging cause of sporadic autochthonous acute hepatitis in Europe. Although spontaneous outcome of hepatitis E is usually favorable, fulminant liver failure has been described worldwide. In Europe, autochthonous hepatitis E associated with fulminant hepatic failure and leading to liver transplantation has been exceptionally reported. We report here four cases of fulminant and sub-fulminant hepatitis E proposed for liver transplantation in Marseille University hospitals between July 2006 and March 2010. HEV diagnosis relied on detection of anti-HEV IgM antibodies and HEV RNA in serum samples. All cases were men, with no travel history in hyperendemic areas. HEV sequence analyses revealed genotype 3 HEV in the four patients. Liver histology indicated severe acute hepatitis in all of them, pre-existing fibrosis being found in two cases. Two patients underwent liver transplantation, and the two other patients could not be transplanted due to septic complications and died. HEV testing should be performed for the initial evaluation of every acute liver failure regardless of the epidemiological and clinical context. With respect to the potentially fulminant evolution of HEV genotype 3 infections, treatment with ribavirin of severe acute hepatitis E should be considered.

A 78-year-old woman with an acute eosinophilic gastroenteritis.

Eosinophil accumulation in the gastrointestinal tract is a common feature of numerous disorders including mainly parasitic infection, drug-induced allergic reactions, inflammatory bowel disease, and various connective tissue disorders. Digestive tissue eosinophilia requires thorough searching for secondary causes that may be specifically treated with antibiotics, dietary and drug elimination or immunosuppressive therapy. Frequency, prognosis and therapeutic implications must guide the diagnostic course. An acute eosinophilic gastroenteritis in a 78-year-old asthmatic woman receiving celecoxib is reported. She presented later with neurologic and cutaneous features and was finally treated by methylprednisolone and cyclophosphamide. The diagnostic approach leading to a Churg-Strauss syndrome (CSS) assertion is described. We discuss the pathogenesis, the management and the potential enhancing role of celecoxib in CSS gastrointestinal involvement.

Acute pancreatitis: a rare complication of acute hepatitis E.

Hepatitis E is an emerging imported disease in Europa but autochthonous cases are described for some years. Extra-hepatic associated manifestations are published. We report a case of acute necrotizing pancreatitis associated with imported acute viral E hepatitis (genotype 1a) in a 26 years old French man travelling and originated from Pakistan. The outcome is favourable spontaneously in two months. This life-threatening hepatitis E related complication is unknown in Europa where genotype 3 virus strains prevail. The clinical presentation is stereotyped with the onset of pancreatitis in the second or third weeks of hepatitis evolution in an Indian male in his second or third decade infected with genotype 1 strain. No pancreatitis-related death is reported in the 13 previous reported cases.

[Curative short term treatment of chronic viral C hepatitis]. / Traitement curatif de courte durée de l'hépatite chronique virale C.

INTRODUCTION: Chronic viral C hepatitis can be cured by shorter treatment than recommended. It is illustrated by our two case reports. CASES: We report two cases of chronic viral C hepatitis cured by short therapy with interferon standard alone in one case and the combination of pegylated-interferon and ribavirin in the second case. Genotype was undetermined for one patient and 3a for the other. DISCUSSION: Excepted genotyping and early testing of viral load decrease during treatment (12th week), we lack early predictive factors of sustained response that could help avoid prolonged, poorly tolerated therapy in future non-responders. These observations show that the treatment duration of chronic viral C hepatitis can be shortened in selected patients, who should be identified as soon as possible after the beginning of the treatment.

[Autochthonous hepatitis E virus in Southeastern France. 2 cases]. / Hépatite virale E autochtone dans le sud-est de la France. Deux observations.

INTRODUCTION: Hepatitis E virus is endemic in developing countries where it is especially lethal among pregnant women. As the circulation of goods and people grows between these countries and the industrialized nations, this virus is emerging as a cause of imported acute hepatitis in the latter, where authentic autochthonous cases also exist. OBSERVATIONS: We report two cases observed in Marseille, in men aged 27 and 81 years; no mode of contamination was detected, and both outcomes were positive. DISCUSSION: This virus is circulating in non-endemic areas (as shown by its seroprevalence, which ranges from 0.4 to 2.6%, its identification in urban sewage, and the autochthonous cases reported). This dissemination, combined with its high mortality rate, even outside pregnancy (up to 12%), show the need for systematic consideration of and an early search for the often-fleeting presence of the virus and of IgM and IgG type serum antibodies in plasma and (when necessary) feces in cases of acute hepatitis, because of their often transient nature. Prophylaxis is based on improving water hygiene and is thus more difficult in industrialized countries where the level of hygiene is already high, especially when no risk factors can be identified in the autochthonous cases. Recombinant vaccines are under development.