Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1358
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
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.
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.
This unique case invokes the importance of HEV surveillance and treatment among cirrhotic patients, HCC cases, and blood donors.
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.