TY - JOUR
T1 - Persistent Hepatitis E Infection in a Patient with Tuberous Sclerosis Complex Treated with Everolimus
T2 - A Case Report
AU - van Dijk, Wobke E.M.
AU - Vergeer, Menno A.M.H.
AU - Arends, Joop E.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Introduction: The incidence of hepatitis E (HEV) genotype 3 is rising in developed countries. HEV infections are usually self-limiting, but can become chronic in immunocompromised patients. This might lead to rapid fibrosis development even resulting in cirrhosis. Chronic HEV is mainly described in patients after solid-organ or hematological transplantations. We present the first case of HEV infection in a patient with tuberous sclerosis complex (TSC) treated with everolimus, a mammalian target of rapamycin (mTOR) inhibitor. Case: A 46-year-old male with TSC was referred to the infectious diseases department with an acute rise of liver enzymes during routine laboratory check-up. He was diagnosed with an acute HEV infection. His current treatment for TSC was everolimus. After awaiting a spontaneous clearance for 3 months, everolimus was discontinued. Hereafter, the infection was cleared within another 3 months. Discussion: Due to a favorable side-effect profile, everolimus is gaining popularity as an immunosuppressive therapy. However, in vitro experiments suggest that inhibition of mTOR leads to a significant increase in HEV replication. Thus far, there have been no clinical reports of HEV infections in patients treated with everolimus. Conclusion: Due to higher dosing of everolimus in TSC patients, they are more vulnerable to the development of chronic HEV infection. Periodic assessment of transaminases in these patients is advised.
AB - Introduction: The incidence of hepatitis E (HEV) genotype 3 is rising in developed countries. HEV infections are usually self-limiting, but can become chronic in immunocompromised patients. This might lead to rapid fibrosis development even resulting in cirrhosis. Chronic HEV is mainly described in patients after solid-organ or hematological transplantations. We present the first case of HEV infection in a patient with tuberous sclerosis complex (TSC) treated with everolimus, a mammalian target of rapamycin (mTOR) inhibitor. Case: A 46-year-old male with TSC was referred to the infectious diseases department with an acute rise of liver enzymes during routine laboratory check-up. He was diagnosed with an acute HEV infection. His current treatment for TSC was everolimus. After awaiting a spontaneous clearance for 3 months, everolimus was discontinued. Hereafter, the infection was cleared within another 3 months. Discussion: Due to a favorable side-effect profile, everolimus is gaining popularity as an immunosuppressive therapy. However, in vitro experiments suggest that inhibition of mTOR leads to a significant increase in HEV replication. Thus far, there have been no clinical reports of HEV infections in patients treated with everolimus. Conclusion: Due to higher dosing of everolimus in TSC patients, they are more vulnerable to the development of chronic HEV infection. Periodic assessment of transaminases in these patients is advised.
KW - Chronic hepatitis E
KW - Everolimus
KW - Hepatitis E
KW - mTOR-inhibitor
KW - Tuberous sclerosis complex
UR - http://www.scopus.com/inward/record.url?scp=85020028850&partnerID=8YFLogxK
U2 - 10.1007/s40121-017-0147-0
DO - 10.1007/s40121-017-0147-0
M3 - Article
AN - SCOPUS:85020028850
SN - 2193-8229
VL - 6
SP - 291
EP - 295
JO - Infectious Diseases and Therapy
JF - Infectious Diseases and Therapy
IS - 2
ER -