Summary
Hepatitis E virus (HEV) infections are not limited to the liver but may also affect
other organs. Several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy,
glomerulonephritis, cryoglobulinemia, pancreatitis, lymphoma, thrombopenia, meningitis,
thyroiditis and myocarditis have been observed in the context of hepatitis E. To date,
the definite pathophysiological links between HEV and extrahepatic manifestations
are not yet established. However, it is suggested that HEV infection might be causative
based on serological studies, case series, in vitro data and animal models. In particular, neuronal and renal diseases as well as pancreatitis
seem to be caused by HEV, while a causative relationship between HEV and other diseases
is more doubtful.
Either direct cytopathic tissue damage by extrahepatic replication, or immunological
processes induced by an overwhelming host immune response, are possible origins of
HEV-associated extrahepatic manifestations.
Hepatologists should be aware of the possibility that acute or chronically HEV-infected
patients could develop extrahepatic manifestations. Neurologists, nephrologists, rheumatologists
and other groups of physicians should consider HEV infection as a potential differential
diagnosis when observing one of the diseases described in this review.
Ribavirin and steroids have been used in small groups of patients with extrahepatic
manifestations of HEV, but the efficacy of these drugs still needs to be verified
by large, multicenter studies.
This article comprehensively reviews the published literature regarding HEV and extrahepatic
manifestations. We discuss the probability of specific extrahepatic diseases being
caused by previous or ongoing HEV infection, and summarize the published knowledge
about antiviral treatment in extrahepatic disorders.
Keywords
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Article info
Publication history
Published online: November 29, 2016
Accepted:
November 20,
2016
Received in revised form:
November 13,
2016
Received:
July 7,
2016
Identification
Copyright
© 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
