Hepatitis aguda por virus E con características de autoinmunidad. Reporte de un caso

We analyze the case of a 49-year-old male patient who presented with clinical signs of acute hepatitis with an initial suspicion of autoimmune etiology. Laboratory findings demonstrated positive antinuclear antibody, anti-smooth muscle antibody and high serum gamma globulin. Histology of the liver biopsy revealed changes compatible with autoimmune hepatitis, which associated with an International Autoimmune Hepatitis Group score of 7, determined the initiation of treatment with Meprednisolone and Azathioprine. During the follow-up, we received positive serological results of immunoglobulin M against hepatitis E virus with detectable viremia by reverse transcription polymerase chain reaction technique, changing the diagnosis to acute hepatitis secondary to hepatitis E virus. Immunosuppression was suspended and the patient continued with clinical and biochemical improvement. In Argentina, hepatitis E virus testing is not routinely performed, however, to avoid misdiagnosis, this etiology should be ruled out in patients with acute hepatitis before labeling it as autoimmune hepatitis. This could reduce unnecessary treatment that could endanger our patients.