Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2020; 12(12): 1358-1366
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1358
Hepatitis E virus re-infection accelerates hepatocellular carcinoma development and relapse in a patient with liver cirrhosis: A case report and review of literature
Xiao-Na Lin, Qiu-Xiong Lin, Shu-Mei Li, Ke-Ping Xie, Jun Hou, Ren Chen
Xiao-Na Lin, Jun Hou, The Laboratory of Computational Medicine and Systems Biology, School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong Province, China
Qiu-Xiong Lin, Shu-Mei Li, Ren Chen, Department of Infectious Disease, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Ke-Ping Xie, School of Medicine, South China University of Technology, Guangzhou 510000, Guangdong Province, China
Author contributions: Lin XN, Lin QX, Hou J, and Chen R conceived the presented idea and wrote the manuscript; Lin XN, Lin QX, Li SM, Xie KP, and Chen R performed the data collection; Lin XN and Hou J analyzed the data; Lin XN, Lin QX, Hou J, and Chen R interpreted the results; Hou J and Chen R supervised the project; and all authors discussed the results and contributed to the final manuscript.
Supported by Guangzhou Science Technology and Innovation Commission, No. 201807010107.
Informed consent statement: The patient provided written informed consent to participate in this study. Written informed consent was obtained for the publication of any potentially identifiable images or data included in this article.
Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ren Chen, MD, PhD, Chief Doctor, Department of Infectious Disease, Guangdong General Hospital & Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China. crlmczx@163.com
Received: August 6, 2020
Peer-review started: August 1, 2020
First decision: September 21, 2020
Revised: October 4, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: December 27, 2020
Processing time: 134 Days and 2.8 Hours
Abstract
BACKGROUND

Hepatitis E virus (HEV) superinfection is a suspected promoting factor for hepatocellular carcinoma (HCC) in patients with chronic hepatitis and cirrhosis. However, to date, very few cases of HEV-related HCC have been reported. Nevertheless, the role of HEV re-infection in cirrhotic liver without other chronic hepatitis infections has rarely been explored.

CASE SUMMARY

A 53-year-old male farmer was diagnosed with liver cirrhosis and splenomegaly in August 2016, accompanied with negative HEV-IgM and positive HEV-IgG. No evidence of hepatitis B virus or hepatitis C virus infection was found. Since then the patient was evaluated for liver function and viral parameters every 3 mo. In June 2017, the patient presented severe fatigue with whole body itching and was diagnosed with HCC. Afterwards this patient experienced quick HCC development, progression, relapse, and metastasis in the following 8 mo, and presented persistent dual positivity of HEV-IgM and HEV-IgG. This patient had a long history of smoking and alcohol consumption.

CONCLUSION

This unique case invokes the importance of HEV surveillance and treatment among cirrhotic patients, HCC cases, and blood donors.

Keywords: Hepatitis E virus; Re-infection; Hepatocellular carcinoma; Cirrhosis; Case report

Core Tip: The role of chronic hepatitis E virus (HEV) superinfection in hepatocellular carcinoma (HCC) progression in cirrhotic patients with negative hepatitis B virus (HBV) infection has not been studied. We present herein a unique chronic HEV case with liver cirrhosis who experienced repeated HEV re-infection and rapid HCC development and relapse. This case highlights the importance to investigate the association between HEV re-infection and rapid development of HCC and progression in liver cirrhosis cases, even in the absence of HBV infection. Moreover, routinely detecting HEV infection in high risk occupational group and all blood donors is warranted. Additionally, the treatment for symptomatic and asymptomatic chronic HEV infection is highly suggested.