Zusammenfassung
Eine 58-jährige Patientin wurde vom Hausarzt mit dem Bild einer unklaren akuten Hepatopathie vorgestellt. Bei der Patientin lag eine seit Jahren bekannte genetische Hämochromatose ohne zirrhotischen Umbau vor. Laborchemisch bot sich initial ein hepatitisches Bild (ALAT [Alaninaminotransferase] 3 871 U/l, ASAT [Aspartataminotransferase] 2 004 U/l, Bilirubin 6,7 mg/dl, γ-GT [γ-Glutamyltransferase] 503 U/l). Bei unauffälliger laborchemischer Differentialdiagnostik für virale, autoimmune und zusätzliche metabolische Lebererkrankungen wurde aufgrund einer auffälligen Reiseanamnese (Afrikaaufenthalt vor ca. 5 Monaten) ergänzend eine Hepatitis-E-Diagnostik durchgeführt. Überraschenderweise konnten ein positives Anti-HEV-(Hepatitis-E-Virus-) IgM bei negativem Anti-HEV-IgG sowie eine positive HEV-RNA nachgewiesen werden. Somit wurde die Diagnose einer akuten Hepatitis E gestellt. Bei letztlich nicht passender Inkubationszeit in Bezug auf den Afrikaaufenthalt sowie unauffälligem privaten Umfeld der Patientin muss hier, wie in der Literatur beschrieben, eine zoonotische Genese der Hepatitis E vermutet werden.
Abstract
A 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, γ-GT [γ-glutamyl transferase] 503 U/l). The patient’s medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molec ular biological tests. There was no diagnostic evidence for underlying autoim - mune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patient’s social environment, so that a zoonotic origin has to be discussed.
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Vetter, S., Hartmann, D., Jakobs, R. et al. Seltene akute Hepatitis bei einer Hämochromatosepatientin: eine Zoonose?. Med Klin 105, 305–309 (2010). https://doi.org/10.1007/s00063-010-1039-1
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DOI: https://doi.org/10.1007/s00063-010-1039-1