Acute viral hepatitis E complicated with acute pancreatitis in an immunocompetent adult

Acute viral hepatitis has been associated with several extrahepatic complications. Fulminant liver failure secondary to acute viral hepatitis may be complicated by acute pancreatitis. However, in the setting of benign viral hepatitis, in the absence of liver failure, association of pancreatitis is uncommon, that too in an otherwise immunocompetent individual. The exact mechanism of hepatitis-related pancreatitis remains elusive. Proposed mechanisms include immune-mediated injury against infected pancreatic acinar cells, oedema of the ampulla of Vater and release of lysosomal enzymes from the liver. A high index of clinical suspicion is needed in any case of viral hepatitis with severe abdominal pain to recognise acute pancreatitis as a possible complication, which may increase both morbidity and mortality if unrecognised. Herein, we report a case of a young man presenting with acute viral hepatitis due to hepatitis E infection, complicated by acute pancreatitis.

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Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection: A Case Report and Review

Case Reports in Hepatology ◽

10.1155/2013/531235 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Hemanta Kumar Nayak ◽

Nitish L. Kamble ◽

Nishant Raizada ◽

Sandeep Garg ◽

Mradul Kumar Daga

Keyword(s):

Acute Pancreatitis ◽

Virus Infection ◽

Acute Hepatitis ◽

Viral Hepatitis ◽

Hepatitis E Virus ◽

Acute Viral Hepatitis ◽

Young Male ◽

Hepatitis E ◽

Unusual Complication ◽

Acute Hepatitis E

Acute pancreatitis complicating fulminant viral hepatitis has been well recognized; however, acute pancreatitis occurring in nonfulminant hepatitis is very rare. The case presented describes moderate pancreatitis in a young male, manifesting during the course of nonfulminant acute hepatitis E infection. The diagnosis of acute viral hepatitis E was confirmed by serology and reverse transcriptase polymerase chain reaction (RT-PCR) to demonstrate Hepatitis E virus (HEV) RNA in both stool and serum. Patients with acute viral hepatitis presenting with severe abdominal pain should have a diagnosis of acute pancreatitis suspected and appropriate investigations including serum amylase, lipase, biliary ultrasonography and/or contrast-enhanced computed tomography of the abdomen should be undertaken. The identification of this unusual complication of Hepatitis E is important; however, the prognosis for patients with Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection is good, and uncomplicated recovery with conservative treatment is expected.

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Pancreatic Involvement in Non Fulminant Acute Viral Hepatitis

JMS SKIMS ◽

10.33883/jms.v15i1.108 ◽

2012 ◽

Vol 15 (1) ◽

pp. 44-46

Author(s):

Gul Javid ◽

Riyaz U Saif ◽

Abid Shoukat ◽

Asif Iqbal ◽

Mohamad Yousuf ◽

...

Keyword(s):

Acute Pancreatitis ◽

Acute Hepatitis ◽

Viral Hepatitis ◽

Acute Viral Hepatitis ◽

Hepatitis E ◽

Young Males ◽

Pancreatic Involvement ◽

Biliary Pathology ◽

Study Association ◽

A Prospective Study

BACKGROUND: Biliary pathology and alcoholism are responsible for 70 to 80% cases of acute pancreatitis. Viral etiology is not uncommon. OBJECTIVE: To study association of nonfulmimant acute hepatitis with acute pancreatitis. METHODS: We undertook a prospective study over 3 years from Jan 2009 to Dec 2011, during which 950 patients got admitted as acute pancreatitis. RESULTS: Four patients (4.2%) were diagnosed with acute pancreatitis which developed after acute hepatitis. All patients were young (15-36 years); three males and one female. Two patients had pancreatitis in first week and two in third week, after onset of jaundice. Three patients had mild pancreatitis and one had sever pancreatitis. The etiology of pancreatitis was hepatitis A in two, and hepatitis E and hepatitis B in one each. All patients were managed conservatively and recovered completely. CONCLUSIONS: Association between acute pancreatitis and acute viral hepatitis is now more frequently recognized; more commonly in young males, between 1st and third week of hepatitis illness. JMS 2012;15(1):44-46.

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Acute Pancreatitis in acute viral hepatitis

Journal of Nepal Medical Association ◽

10.31729/jnma.20 ◽

2011 ◽

Vol 51 (181) ◽

Author(s):

S K.C. ◽

S Khadka ◽

D Sharma ◽

SP Chataut

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Viral Hepatitis ◽

Hepatitis A ◽

Acute Viral Hepatitis ◽

Ultrasound Examination ◽

Hepatitis E ◽

Severe Abdominal Pain ◽

Gastric Ulcers ◽

Pancreatic Involvement

Introduction: The association of acute viral hepatitis and acute pancreatitis is well described. This study was conducted to find out the frequency of pancreatic involvement in acute viral hepatitis in the Nepalese population. Methods: Consecutive patients of acute viral hepatitis presenting with severe abdominal pain between January 2005 and April 2010 were studied. Patients with history of significant alcohol consumption and gall stones were excluded. Acute viral hepatitis was diagnosed by clinical examination, liver function test, ultrasound examination and confirmed by viral serology. Pancreatitis was diagnosed by clinical presentation, biochemistry, ultrasound examination and CT scan. Results: Severe abdominal pain was present in 38 of 382 serologically-confirmed acute viral hepatitis patients. Twenty five patients were diagnosed to have acute pancreatitis. The pancreatitis was mild in 14 and severe in 11 patients. The etiology of pancreatitis was hepatitis E virus in 18 and hepatitis A virus in 7 patients. Two patients died of complications secondary to shock. The remaining patients recovered from both pancreatitis and hepatitis on conservative treatment. Conclusions: Acute pancreatitis occurred in 6.5 % of patients with acute viral hepatitis. Cholelithiasis and gastric ulcers are the other causes of severe abdominal pain. The majority of the patients recover with conservative management. Keywords: acute viral hepatitis, acute pancreatitis, pain abdomen, hepatitis E, hepatitis A, endemic zone

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Hepatitis-E: Clinical profile and outcome assessment from India

Medpusle International Journal of Medicine ◽

10.26611/102111217 ◽

2021 ◽

Vol 11 (2) ◽

pp. 139-141

Author(s):

Venu H Aradya ◽

Keyword(s):

Liver Disease ◽

Liver Failure ◽

Viral Hepatitis ◽

Acute Viral Hepatitis ◽

Tertiary Care ◽

Hepatitis E ◽

Chronic Liver ◽

Enzyme Linked Immunosorbent Assay ◽

Care Hospital ◽

Study Results

Background: Hepatitis E is the most common cause of acute viral hepatitis in the adult population in India. Hepatitis-E has self-limiting clinical course, but can be life threatening in certain high risk groups like pregnancy and alcoholic liver disease. . The present study evaluated the predictors of mortality in patients with acute Hepatitis-E cases at a tertiary care center from India. Methods: This cross sectional study including cases of viral Hepatitis E was done at tertiary care hospital at Mysore during January 2016 to November 2016. A total of seventy nine patients diagnosed with HEV infection using IgM anti-HEV enzyme-linked immunosorbent assay (ELISA) kits were included in the study. Results: Out of seventy nine, forty two (53.2%) patients were males and thirty seven (46.8%) were females. The mean age of our study group was 44.3±13.47 years. Out of seventy nine Hepatitis E patients, six had coinfection, two with Hepatitis A (2.5%) and four (5.1%) were HBsAg positive. A total of seventy three (92.4%) patients survived while six (7.6%) patients expired during the course of the illness. Among six fatal cases, four (66.7%) died of acute on chronic liver failure and two (33.6%) died of acute liver failure (ALF). Conclusion: Pre-existing chronic liver disease was found to be significantly associated with mortality in patients suffering from viral Hepatitis E. Increased bilirubin, Low serum albumin, alcohol use, were also associated with increased mortality due to acute viral hepatitis E. Pregnancy was not a determinant of mortality in Hepatitis-E patients in this study.

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Acute viral hepatitis B complicated by acute pancreatitis.

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v16i3.32874 ◽

2017 ◽

Vol 16 (3) ◽

pp. 455-457

Author(s):

Mohammad Mushtaque Ahmad ◽

Praveen Kumar Malik ◽

Abhinav Jain ◽

Shridhar Dwivedi

Keyword(s):

Acute Pancreatitis ◽

Hepatitis B ◽

Liver Failure ◽

Viral Hepatitis ◽

Acute Viral Hepatitis ◽

Medical Science ◽

Radiological Features ◽

Severe Pancreatitis ◽

Acute Hepatitis B ◽

Viral Hepatitis B

Majority of acute viral hepatitis cases resolve spontaneously in due course of time. Few cases that develop acute liver failure are prone to develop various complications, including acute pancreatitis. However, development of acute pancreatitis in patients with uncomplicated acute viral hepatitis is very rare and extremely rare in case of Acute Hepatitis B. In this case, a young boy with acute non-fulminant hepatitis B developed acute moderately severe pancreatitis, diagnosed by clinical, enzymatic and radiological features. He was managed conservatively and improved. Acute pancreatitis must be considered in patients with acute viral hepatitis who develop abdominal pain.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.455-457

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Seroprevalence of hepatitis A virus and hepatitis E virus among the patients presenting with acute viral hepatitis admitted in a tertiary care center located in Central India

Menoufia Medical Journal ◽

10.4103/mmj.mmj_153_20 ◽

2021 ◽

Vol 34 (2) ◽

pp. 582

Author(s):

Trupti Bajpai ◽

Prachi Shaw ◽

Maneesha Pandey ◽

Jinwal Meena ◽

Neelesh Gagrani

Keyword(s):

Viral Hepatitis ◽

Hepatitis E Virus ◽

Hepatitis A ◽

Acute Viral Hepatitis ◽

Hepatitis A Virus ◽

Care Center ◽

Tertiary Care ◽

Central India ◽

Hepatitis E ◽

Tertiary Care Center

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A Case of Acute Hepatitis E Complicated by Acute Pancreatitis in Eastern India

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v12i2.513 ◽

2020 ◽

Vol 12 (2) ◽

Author(s):

Rudrajit P ◽

Shubhabrata D ◽

Sourav P ◽

Partha SC ◽

Jayati M ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Acute Hepatitis ◽

Viral Hepatitis ◽

Hepatitis A ◽

Young Male ◽

Hepatitis E ◽

Uneventful Recovery ◽

Eastern India ◽

Acute Hepatitis E

Viral hepatitis may be occasionally associated with acute pancreatitis. Usually the patient presents with abdominal pain in the second or third week of illness. Hepatitis A or E viruses are mostly implicated. HEV related acute pancreatitis was first reported only 12 years ago. We report a case of a young male presenting with acute Hepatitis E infection complicated by pancreatitis. He had an uneventful recovery. This is probably the first report of this association from Eastern India.

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Case report: Acute Hepatitis E Infection with Co-Existent Glucose-6-Phosphate Dehydrogenase Deficiency

Canadian Journal of Infectious Diseases ◽

10.1155/2003/913679 ◽

2003 ◽

Vol 14 (4) ◽

pp. 230-231 ◽

Cited By ~ 16

Author(s):

Amitabh Monga ◽

Ravinder PS Makkar ◽

Anju Arora ◽

Surabhi Mukhopadhyay ◽

Ajay K Gupta

Keyword(s):

Viral Hepatitis ◽

G6pd Deficiency ◽

Hepatitis E Virus ◽

Dehydrogenase Deficiency ◽

Acute Viral Hepatitis ◽

Hepatitis E ◽

Severe Anemia ◽

Northern India ◽

Acute Hepatitis E ◽

Glucose 6 Phosphate Dehydrogenase

Hepatitis E virus is one of the leading causes of acute viral hepatitis in India but usually manifests as a mild self-limiting illness. Viral hepatitis in the presence of glucose-6-phosphate dehydrogenase (G6PD) deficiency may be associated with complications such as severe anemia, hemolysis, renal failure, hepatic encephalopathy and even death. The incidence of G6PD deficiency in the general population of northern India is reported to be between 2.2% and 14%. Despite both hepatitis E infection and G6PD deficiency being common, their impact on patient illness has only recently been reported. The present study reports a case of severe hemolysis in a patient with G6PD deficiency and hepatitis E infection.

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