Persistent Hepatitis E Infection in a Patient with Tuberous Sclerosis Complex Treated with Everolimus: A Case Report

Introduction The incidence of hepatitis E (HEV) genotype 3 is rising in developed countries. HEV infections are usually self-limiting, but can become chronic in immunocompromised patients. This might lead to rapid fibrosis development even resulting in cirrhosis. Chronic HEV is mainly described in p...

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Bibliographic Details
Published in:Infectious diseases and therapy 2017-06, Vol.6 (2), p.291-295
Main Authors: van Dijk, Wobke E. M., Vergeer, Menno A. M. H., Arends, Joop E.
Format: Article
Language:English
Subjects:
Case Report
Case reports
Clinical outcomes
Developed countries
Drug therapy
Genetic disorders
Hepatitis
Infectious Diseases
Inhibitor drugs
Internal Medicine
Liver cirrhosis
Medicine
Medicine & Public Health
Tuberous sclerosis
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Summary:Introduction The incidence of hepatitis E (HEV) genotype 3 is rising in developed countries. HEV infections are usually self-limiting, but can become chronic in immunocompromised patients. This might lead to rapid fibrosis development even resulting in cirrhosis. Chronic HEV is mainly described in patients after solid-organ or hematological transplantations. We present the first case of HEV infection in a patient with tuberous sclerosis complex (TSC) treated with everolimus, a mammalian target of rapamycin (mTOR) inhibitor. Case A 46-year-old male with TSC was referred to the infectious diseases department with an acute rise of liver enzymes during routine laboratory check-up. He was diagnosed with an acute HEV infection. His current treatment for TSC was everolimus. After awaiting a spontaneous clearance for 3 months, everolimus was discontinued. Hereafter, the infection was cleared within another 3 months. Discussion Due to a favorable side-effect profile, everolimus is gaining popularity as an immunosuppressive therapy. However, in vitro experiments suggest that inhibition of mTOR leads to a significant increase in HEV replication. Thus far, there have been no clinical reports of HEV infections in patients treated with everolimus. Conclusion Due to higher dosing of everolimus in TSC patients, they are more vulnerable to the development of chronic HEV infection. Periodic assessment of transaminases in these patients is advised.
ISSN:2193-8229
2193-6382
DOI:10.1007/s40121-017-0147-0