Hepatitis E Infection in Patients With IBD Treated With Advanced Therapy: A Case Series

ABSTRACT Background and Aims Hepatitis E virus is an RNA virus with 8 genotypes. Infection is usually acute and asymptomatic, but chronic infection may develop in immunocompromised individuals. Data on the course of hepatitis E virus infection in patients with inflammatory bowel disease receiving advanced therapy are limited. We aimed to describe the clinical course and outcomes of hepatitis E virus infection in this population. Methods We conducted a case series of consecutive patients with inflammatory bowel disease receiving biologic or small molecule therapy who were diagnosed with hepatitis E virus infection. Before the diagnosis, patients underwent detailed differential diagnosis of elevated transaminases. Hepatitis E virus infection was confirmed by positive serology and detectable viremia using quantitative polymerase chain reaction. Patients underwent regular clinical and laboratory follow‐up after interruption of advanced therapy. Results Hepatitis E virus infection was detected in 7 patients, 2 with Crohn's disease and 5 with ulcerative colitis. Infection was asymptomatic or mild in all cases and detected due to newly elevated transaminases. No patient developed liver dysfunction. Transaminases normalized within a median of 4 weeks. Viremia declined rapidly and was undetectable in all patients by week 12. No chronic infection occurred. All patients resumed advanced therapy without complications. One pregnant patient had an uncomplicated course and delivered a healthy infant. Conclusions In this case series, hepatitis E virus infection in patients with inflammatory bowel disease receiving advanced therapy had an acute and benign course, with no progression to chronic infection.