De-Novo Autoimmune Hepatitis with Consecutive Acute Liver Failure Induced by Hepatitis E Infection: A Case Report

: A 49-year-old male patient was referred to our institution for acute liver failure (ALV). Apart from cholestasis, coagulopathy, and hepatic encephalopathy (HE) I°, laboratory studies revealed a significant increase in liver enzymes with an alanine aminotransferase (ALT) level of 4’108 U/L and an aspartate aminotransferase (AST) level of 3’878 U/l (normal < 50 U/L), a constellation essentially compatible with autoimmune hepatitis (AIH). Work-up of serological markers for hepatitis E (HEV-IgM and PCR) was at the same time positive. Furthermore, the patient was strongly positive for antinuclear autoantibodies (ANA) with a titer of 1:1’280 (normal upper limit 1:80), and also presented hypergammaglobulinemia (immunoglobulin IgG-level of 21.3 g/L; normal 7, 0 - 16, 0 g/L). Liver histology demonstrated massive hepatitis and necrosis with the presence of plasma cells. Due to the diagnosis of de-novo autoimmune hepatitis, therapy with steroids was performed despite the evidence of acute HEV-infection. It was of great importance that the patient recovered completely while neither antiviral therapy with ribavirin nor liver transplantation (LT) was necessary in the further course.