Vol.:(0123456789) 1 3 Clinical Journal of Gastroenterology https://doi.org/10.1007/s12328-019-01024-3 CASE REPORT The spontaneous clearance of hepatitis E virus (HEV) and emergence of HEV antibodies in a transfusion‑transmitted chronic hepatitis E case after completion of chemotherapy for acute myeloid leukemia Hiroshi Okano 1  · Tatsunori Nakano 2  · Ryugo Ito 3  · Ami Tanaka 4  · Yuji Hoshi 4  · Keiji Matsubayashi 4  · Hiroki Asakawa 1  · Kenji Nose 1  · Satomi Tsuruga 1  · Tomomasa Tochio 1  · Hiroaki Kumazawa 1  · Yoshiaki Isono 1  · Hiroki Tanaka 1  · Shimpei Matsusaki 1  · Tomohiro Sase 1  · Tomonori Saito 1  · Katsumi Mukai 1  · Akira Nishimura 1  · Keiki Kawakami 3  · Shigeo Nagashima 5  · Masaharu Takahashi 5  · Hiroaki Okamoto 5 Received: 30 April 2019 / Accepted: 18 July 2019 © Japanese Society of Gastroenterology 2019 Abstract A 64-year-old woman was infected with hepatitis E virus (HEV) during chemotherapy for leukemia. By retrospective analyses of stored serum from the blood products and the patient, the source of the infection was determined to be platelet concentra- tion (PC) transfused during chemotherapy. The partial nucleotide sequence of the HEV strain isolated from the donated PC and that from the patient’s sera was identical and was subgenotype 3b. Clinical indicators such as alanine aminotransferase, HEV RNA titer, and anti-HEV antibodies in the serum were investigated from the beginning of the infection until 1 year after the termination of HEV infection. HEV RNA had propagated over 6 months and then cleared spontaneously after the completion of chemotherapy. Anti-HEV antibodies appeared in the serum just before the clearance of HEV RNA. Interest- ingly, HEV RNA was detected in the patient’s urine, spinal fluid, and saliva. The HEV RNA titers in those samples were much lower than in the serum and feces. No renal, neurological, or salivary gland disorders appeared during the follow-up. We observed virological and biochemical progress and cure of transfusion-transmitted chronic hepatitis E in the patient despite an immunosuppressive status during and after chemotherapy against hematological malignancy. Keywords Chemotherapy · Hepatitis E · Hematological malignancy · Immunosuppression · Transfusion Introduction Hepatitis E virus (HEV) infection causes hepatitis E out- breaks in developing countries, where water sources are sometimes contaminated by HEV. Hepatitis E virus also causes sporadic and cluster cases of hepatitis E with char- acteristics of zoonosis in developed countries [1, 2]. Blood- borne transmission through the transfusion of blood products contaminated with HEV is also an important transmission route of HEV [3]. In Japan, 19 cases of transfusion-trans- mitted hepatitis E have been reported [3]. Hepatitis E virus infection is diagnosed based on the pres- ence of anti-HEV IgM/IgA and/or HEV RNA in the serum of patients. It was reported that HEV infection under immu- nosuppressive condition sometimes presents with prolonged HEV viremia [4–8] and a delay or prevention of seroconver- sion of anti-HEV antibodies [9]. However, data concerning the long-term dynamics of HEV RNA and HEV-specific Hiroshi Okano and Tatsunori Nakano contributed equally to this work. * Hiroshi Okano oohh1969@yahoo.co.jp 1 Department of Gastroenterology, Suzuka General Hospital, 1275-53 Yasuzuka-cho, Suzuka, Mie 513-8630, Japan 2 Department of Internal Medicine, Fujita Health University Nanakuri Memorial Hospital, 424-1 Oodori-cho, Tsu, Mie 514-1295, Japan 3 Department of Hematology and Oncology, Suzuka General Hospital, 1275-53 Yasuzuka-cho, Suzuka, Mie 513-8630, Japan 4 Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, 1-1-3 Shiba-Daimon, Minato-ku, Tokyo 105-8521, Japan 5 Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan