| Popis: |
A 20-year-old male student was referred to our university hospital with complaints of anorexia, fever and diarrhea on May 10, 1992, having previously made a trip to India and Nepal from February 26 to April 8, 1992. On admission, physical examination revealed a temperature of 37℃, jaundice and hepatosplenomegaly. Blood chemical tests showed the increased levels of aspartate aminotransferase (1,261 IU/L), alanine aminotransferase (2,586 IU/L) and total bilirubin (12.0 mg/dl). He had no history of blood transfusion or habitual intake of alcohol more than 75 g/day or drugs. There were no family members with liver diseases. Positive reactions of antibody to hepatitis E virus were obtained from the sera in the acute and convalescent stages by enzyme linked immunoassay with recombinant synthetic peptide antigen and western blotting with the structural protein of HT3-B. Negative reactions were obtained for HBsAg, anti-HA-IgM and anti-HCV, indicating the absence of hepatitis A, B and C virus infections. The PCR technique also failed to detect HCV-RNA from the patient serum in the acute stage. Other viral markers, such as anti-EB VCA IgM, anti-cytomegalovirus antibody and anti-herpes zoster antibody did not turn out to be positive. Serum levels of aminotransferase and bilirubin decreased, and returned within normal ranges 30 days after the onset of symptoms. These serologic results with clinical symptoms indicated that this patient suffered from acute hepatitis E contracted during the trip to Nepal and India. Thus, the measurement of anti-HEV antibody is recommended in acute hepatitis cases with negative serological results for hepatitis A, B and C in Japan, especially in those with a history of traveling to endemic areas of hepatitis E. |
