Imported acute viral hepatitis E. case report

Case report We present the case of a 54 year-old female patient, which was admitted to the Clinical Hospital for Infectious Diseases “Toma Ciorbă” with 38.5°C temperature, with epigastric and right hypochondriac pain, abdominal discomfort, and jaundice. The clinical exam showed abdominal tenderness on palpation in the epigastric region and in the right hypocondrium, the liver being 2-3 cm below the right costal margin, and the spleen 1-2 cm. Before the admission, the onset of the symptoms was sudden with up to 40°C temperature, pain in the right hypochondrium, permanent nausea, fatigability, decreased appetite and dark urine. Laboratory examination showed: total bilirubin 31.0 μmol/L; direct 7.6; ALAT 1500 U/L; ASAT1300 U/L; alkaline phosphatase726 U/L; GGTP279 U/L; prothrombin index 56%. Personal records: in 2007 the diagnosis of chronic viral hepatitis C was established; bilirubin, ASAT and thymol test with normal values. Markers of viral hepatitis: total anti-HCV positive; total anti-HBc positive; antiHAV IgM negative; anti-HBc IgM negative; anti-HCV IgM positive; anti HDV IgM negative; total anti HDV negative; anti-CMV IgM negative; anti-CMV IgG positive; anti-EBV-VCA IgMnegative; anti EBV-VCA IgG positive; anti-HBs negative; anti-HEV IgM O3positive; anti HEV IgG O3positive. From the epidemiological history it was established that five years before she had travelled to Bulgaria. Instrumental investigations: ultrasonographic examination the liver, right lobe 15.5 cm; the left lobe 6.0 cm; the spleen 12.3x5.0 cm; portal vein 1.0 cm; splenic vein 0.7 cm; FibroScan: the average coefficient of hepatic elasticity 6.8 kPa, which corresponds to F0-F1 stage of hepatic fibrosis (according to the Metavir scale). Symptomatic and pathogenetic administered treatment resulted in clinical and biochemical improvement. The patient was monitored clinically and biochemically at 1 and 2 months. Cytolysis syndrome tests had normal values.