Article Text
Summary
A 58 years old woman, known case of multiple sclerosis, was referred to the acute medical assessment unit for worsening liver function. She was recently started on a new drug (fingolimod) for multiple sclerosis. After excluding common causes of acute hepatitis in the community, a working diagnosis of drug-induced liver injury was made. When liver enzymes kept rising, further investigations were carried out, which revealed acute hepatitis E virus (HEV) infection. This finding was unexpected, as this patient had no risk factor to acquire HEV infection and there was not a single case of HEV diagnosed in our hospital since long time. This case report highlights certain issues like, considering rarest possible diagnosis when meeting such clinical case, concern over the infections which were once thought confined to the developing countries and inclusion of HEV workup in the cases of acute hepatitis when baseline workup is inconclusive.
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Footnotes
Contributors AM, after obtaining consent from the patient, collected related information through interview with the patient and review of case notes. He designed and drafted the report for publication, used PubMed to search for related articles and case reports. He did a thorough review of available literature before presenting it to the consultant for review. JM brought up the idea for writing a case report on this particular case. This patient was admitted under his care and his generous expert opinion helped in to finalise the report. He supported enormously throughout the analysis of data and drafting of report.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.