Acute hepatitis and renal function impairment related to infection by hepatitis E virus in a renal allograft recipient

Clinicians often are faced with an increase in liver enzyme levels. In the majority of cases, the cause is found rapidly. Conversely, in a few cases, the etiologic agent remains unknown and requires either liver biopsy or drug-medication modification. We report a case of acute icteric hepatitis associated with renal function impairment related to infection caused by primary hepatitis E virus (HEV) in a renal transplant recipient who lived in a nonclassic endemic area and had not traveled abroad. Clinicians must be aware that in cases of unexplained hepatitis in organ transplant recipients and in the absence of evident drug hepatotoxicity, HEV should be considered as an etiologic agent for hepatitis. Subsequently, HEV serological tests should be performed, HEV RNA should be looked for in acute-phase serum and stool samples, and liver parameters should be monitored closely because HEV might be responsible, in some cases, for fulminant hepatitis.