Chronic hepatitis E in a patient with Burkitt’s lymphoma


DOI: https://dx.doi.org/10.18565/therapy.2022.3.109-115

Ilchenko L.Yu., Asadi Mobarkhan F.A., Karlsen A.A., Potemkin I.A., Malinnikova E.Yu., Kyuregyan K.K., Mikhailov M.I.

1) I.I. Mechnikov Scientific Research Institute of Vaccines and Serums, Moscow; 2) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 3) M.P. Chumakov Federal Scientific Center of RAS for Research and Development of Immunobiological Prep;arations (Institute of Poliomyelitis), Moscow; 4) Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, Moscow
Abstract. The article presents a description of a clinical case in which hepatitis E virus (HEV) was first detected in a patient with stage IVB Burkitt’s lymphoma during a course of chemotherapy. Since hyperenzymemia in the patient was recorded for 3 months, it was assumed that he had chronic hepatitis E (CHE). Against the background of chemotherapy, the patient was recommended to take ribavirin (RBV), 7 courses of immunosuppressive therapy were performed. Bone marrow and cerebrospinal fluid examination showed no signs of lymphoma progression. HEV was not determined, aminotransferases were within normal limits. Due to the development of leukopenia, the dose of RBV was reduced, the duration of therapy was 4 months. Antibodies to HEV were not detected in the blood serum. 2 months after the completion of CHE therapy, aminotransferase activity was again noted, and HEV, genotype 3, was detected in the patient’s blood serum and fecal masses. Taking into account the recurrence of HEV viremia, RBV therapy was resumed for 8 months. During the control study, normal transaminase indexes were registered, HEV was not detected, anti-HEV IgM/IgG were detected for the first time, which indicated that a complete biochemical and virological response had been achieved. Patient’s monitoring was continued.
Keywords: chronic hepatitis E, Burkitt’s lymphoma, polychemotherapy, ribavirin
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Literature

1. Balayan M.S., Andjaparidze A.G., Savinskaya S.S. et al. Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology. 1983; 20(1): 23–31. https://dx.doi.org/10.1159/000149370.


2. Reyes G.R., Purdy M.A., Kim J.P. et al. Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis. Science. 1990; 247(4948): 1335–39. https://dx.doi.org/10.1126/science.2107574.


3. Khuroo M.S. Discovery of hepatitis E: The epidemic non-A, non-B hepatitis 30 years down the memory lane. Virus Res. 2011; 161(1): 3–14. https://dx.doi.org/10.1016/j.virusres.2011.02.007.


4. Albano L., Vasco M., Benincasa G. et al. Pathogenic mechanisms and current epidemiological status of HEV infection in asymptomatic blood donors and patients with chronic diseases. Eur J Clin Microbiol Infect Dis. 2019; 38(7): 1203–9. https://dx.doi.org/10.1007/s10096-019-03534-x.


5. Lhomme S., Marion O., Abravanel F. et al. Clinical manifestations, pathogenesis and treatment of hepatitis E virus infections. J Clin Med. 2020; 9(2): 331. https://dx.doi.org/10.3390/jcm9020331.


6. Khuroo M.S., Khuroo M.S. Hepatitis E: An emerging global disease – from discovery towards control and cure. J Viral Hepat. 2016; 23(2): 68–79. https://dx.doi.org/10.1111/jvh.12445.


7. Gonzalez Tallo A.I., Vicente V.M., Lindemann M.L.M. [Chronic hepatitis E]. Med Clin (Barc). 2012; 138(2): 69–72. doi: https://dx.doi.org/10.1016/j.medcli.2011.02.003. [Article in Spanish].


8. Pischke S., Peron J-M., von Wulffen M. et al. Chronic hepatitis E in rheumatology and internal medicine patients: A retrospective multicenter European cohort study. Viruses. 2019; 11(2): 186–96. https://dx.doi.org/10.3390/v11020186.


9. Hansrivijit P., Trongtorsak A., Puthenpura M.M. et al. Hepatitis E in solid organ transplant recipients: A systematic review and meta-analysis. World J Gastroenterol. 2021; 27(12): 1240–54. https://dx.doi.org/10.3748/wjg.v27.i12.1240


10. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. 2018; 68(6): 1256–71. https://dx.doi.org/10.1016/j.jhep.2018.03.005.


11. Клинические рекомендации. Лимфома Беркитта у взрослых. Национальное гематологическое общество. Российское профессиональное общество онкогематологов. 2016. Доступ: 2018/06/Limfoma-Berkitta-u-vzroslyh.pdf (дата обращения – 12.03.2022). [Clinical guidelines. Adult Burkitt’s lymphoma. National Hematology Society. Russian Oncohematologists Society. URL: 2018/06/Limfoma-Berkitta-u-vzroslyh.pdf (date access – 12.03.2022). (In Russ.)].


12. Thomas E., Ghany M.G., Liang T.J. The application and mechanism of action of ribavirin in therapy of hepatitis C. Antivir Chem Chemother. 2012; 23(1): 1–12. https://dx.doi.org/10.3851/IMP2125.


13. Deterding K., Grungreiff K., O Lankisch T. et al. Gilbert’s syndrome and antiviral therapy of hepatitis C. Ann Hepatol. 2009; 8(3): 246–50.


14. Tamura A., Shimizu Y.K., Tanaka T. et al. Persistent infection of hepatitis E virus transmitted by blood trans-fusion in a patient with T-cell lymphoma. Hepatol Res. 2007; 37(2): 113–20. https://dx.doi.org/10.1111/j.1872-034X.2007.00024.x.


15. Kamar N., Rostaing L., Legrand-Abravanel F., Izopet J. How should hepatitis E virus infection be defined in organ-transplant recipients? Am J Transplant. 2013; 13(7): 1935–36. https://dx.doi.org/10.1111/ajt.12253.


16. Gerolami R., Moal V., Colson P. Chronic hepatitis E with cirrhosis in a kidney-transplant recipient. N Engl J Med. 2008; 358(8): 859–60. https://dx.doi.org/10.1056/NEJMc0708687.


17. Kamar N., Garrouste C., Haagsma E.B. et al. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants. Gastroenterology. 2011; 140(5): 1481–89. https://dx.doi.org/10.1053/j.gastro.2011.02.050.


18. Rivero-Juarez A., Vallejo N., Lopez-Lopez P. et al. Ribavirin as a first treatment approach for hepatitis E virus infection in transplant recipient patients. Microorganisms. 2020; 8(1): 51-64. https://dx.doi.org/10.3390/microorganisms8010051.


19. Kamar N., Lhomme S., Abravanel F. et al. An early viral response predicts the virological response to ribavirin in hepatitis E virus organ transplant patients. Transplantation 2015; 99(10): 2124–31. https://dx.doi.org/10.1097/TP.0000000000000850.


20. Gorris M., van der Lecq B.M., van Erpecum K.J., de Bruijne J.J. Treatment for chronic hepati-tis E virus infection: A systematic review and meta-analysis. Viral Hepat. 2021; 28(3): 454–63. https://dx.doi.org/10.1111/jvh.13456.


21. Abravanel F., Lhomme S., Rostaing L. et al. Protracted fecal shedding of HEV during ribavirin therapy predicts treatment relapse. Clin Infect Dis. 2015; 60(1): 96–99. https://dx.doi.org/10.1093/cid/ciu742.


22. Soon Ch.F., Behrendt P., Todt D. et al. Defining virus-specific CD8+ TCR repertoires for therapeutic regeneration of T cells against chronic hepatitis E. J Hepatol. 2019; 71(4): 673–84. https://dx.doi.org/10.1016/j.jhep.2019.06.005.


23. Debing Y., Gisa A., Dallmeier K. et al. A mutation in the hepatitis E virus RNA polymerase promotes its replication and associates with ribavirin treatment failure in organ transplant recipients. Gastroenterology. 2014; 147(5):1008–11.e7; quiz e15-6. https://dx.doi.org/10.1053/j.gastro.2014.08.040.


24. Todt D., Gisa A., Radonic A. et al. In vivo evidence for ribavirin-induced mutagenesis of the hepatitis E virus genome. Gut. 2016; 65(10): 1733–43. https://dx.doi.org/10.1136/gutjnl-2015-311000.


25. LeDesma R., Nimgaonkar I., Ploss A. Hepatitis E virus replication. Viruses. 2019; 11(8): 719–21. https://dx.doi.org/10.3390/v11080719.


26. Primadharsini P.P., Nagashima S., Okamoto H. Genetic Variability and Evolution of Hepatitis E Virus. Viruses. 2019; 11(5):456. https://dx.doi.org/10.3390/v11050456.


27. Horvatits T., zur Wiesch J.S., Lutgehetmann M. et al. The clinical perspective on hepatitis E. Viruses. 2019; 11(7): 617–36. https://dx.doi.org/10.3390/v11070617.


28. Fraga M., Gouttenoire J., Sahli R. et al. Sofosbuvir add-on to ribavirin for chronic hepatitis E in a cirrhotic liver transplant recipient: a case report. BMC Gastroenterol. 2019; 19(1): 76–78. https://dx.doi.org/10.1186/s12876-019-0995-z.


29. Melgaco J.G., Gardinali N.R., da Motta de Mello V. et al. Hepatitis E: Update on prevention and control. Biomed Res Int. 2018; 2018: 5769201. https://dx.doi.org/10.1155/2018/5769201.


About the Autors

Lyudmila Yu. Ilchenko, Dr. med. habil., professor, leading researcher at the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums, professor of the Department of hospital therapy named after G.I. Storozhakov of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, leading researcher at the Laboratory for modeling immunobiological processes, M.P. Chumakov Federal Scientific Center of RAS for Research and Development of Immunobiological Preparations (Institute of Poliomyelitis). Address: 115516, Moscow, 26 Bakinskaya Str. E-mail: ilchenko-med@yandex.ru.
ORCID: https://orcid.org/0000-0001-6029-1864
Fedor A. Asadi Mobarkhan, researcher at Research Institute of Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, researcher at the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums. Address: 125284, Moscow, 7/2 2nd Botkinskiy Drive. E-mail: 1amfa@bk.ru. ORCID: https://orcid.org/0000-0002-1838-8037
Anastasia A. Carlsen, leading specialist at the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums. Address: 105064, Moscow, 5A Maliy Kazenniy Lane. E-mail: karlsen12@gmail.com.
ORCID: https://orcid.org/0000-0002-6013-7768
Ilya A. Potemkin, PhD in Medicine, researcher at Research Institute of Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, researcher at the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums. Address: 125284, Moscow, 7/2 2nd Botkinskiy Drive. E-mail: axi0ma@mail.ru. ORCID: https://orcid.org/0000-0001-7559-4219
Elena Yu. Malinnikova, Dr. med. habil., professor, head of the Department of virology, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, leading researcher at the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums. Address: 125445, Moscow, 19/38 Belomorskaya Str. E-mail: malinacgb@mail.ru. ORCID: https://orcid.org/0000-0002-5501-5707
Karen K. Kyureghyan, Dr. habil. biol., professor of RAS, chief researcher at Research Institute of Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, chief researcher at the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums. Address: 125284, Moscow, 7/2 2nd Botkinskiy Drive. E-mail: karen-kyuregyan@yandex.ru.
ORCID: https://orcid.org/0000-0002-3599-117X
Mikhail I. Mikhailov, Dr. med. habil., professor, corresponding member of RAS, scientific director of Research Institute of Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, head of the Laboratory of viral hepatitis, I.I. Mechnikov Scientific Research Institute of Vaccines and Serums. Address: 125284, Moscow, 7/2 2nd Botkinskiy Drive. E-mail: michmich2@yandex.ru.
ORCID: https://orcid.org/0000-0002-6636-6801


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