Acute hepatitis E presenting with fulminant myocarditis and cardiogenic shock: A case report from Nepal

Hepatitis E virus infection is endemic in Nepal and commonly presents as an acute self-limiting hepatitis. Cardiac involvement is extremely rare and may be life-threatening. We report a case of a young female who presented with fever, jaundice, progressive dyspnea and hypotension. Laboratory assessment confirmed acute hepatitis E infection. Chest radiography revealed cardiomegaly with bilateral pulmonary infiltrates. Transthoracic echocardiography demonstrated left ventricular dysfunction. Other infectious causes of myocarditis were excluded. The patient improved with inotropic support, heart failure treatment and other supportive management, with complete clinical recovery on follow-up. This case highlights the importance of early cardiac evaluation in patients with acute hepatitis E with features of heart failure.