Infection with hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide, now increasingly recognized also in nonendemic regions. Clinical manifestation of hepatitis E includes mostly asymptomatic/subclinical presentations or acute, self-limiting hepatitis, but also potentially fatal liver failure or chronic hepatitis in immunocompromised individuals. Accordingly, hepatitis E histolpathologic patterns range from an unremarkable histology over acute (cholestatic) hepatitis with variable degree of necrosis to chronic hepatitis with fibrosis. Awareness of hepatitis E and its differential diagnoses, knowledge of its clinico-pathologic manifestations and familiarity with its diagnostic tools will enable clinicians and pathologists to competently make this diagnosis.
Key points
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Hepatitis E virus (HEV), a fecally-orally transmitted RNA virus, occurring endemically as well as sporadically, is a leading cause of acute hepatitis worldwide.
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Of the 4 major genotypes infecting humans, genotypes 1 and 2 are restricted to humans, whereas genotypes 3 and 4 also are zoonosis.
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Hepatitis E is generally self-limited, presenting similar to other forms of acute hepatitis, but rarely leads to fulminant liver failure, or takes a chronic course in immunocompromised individuals.
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Hepatitis E displays a spectrum of histological changes which, besides the typical acute (cholestatic) hepatitis pattern, also comprises fulminant cases with (sub)-total necrosis and chronic hepatitis prone to fibrosis development.
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Awareness of HEV, familiarity with its clinical and histopathologic spectrum, and knowledge of diagnostic tools will enable clinicians and pathologists to reliably and promptly diagnose HEV.
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