BMJ Case Reports 2018; doi:10.1136/bcr-2017-223616
  • Unusual association of diseases/symptoms

Acute hepatitis E superinfection leading to chronic hepatitis B reactivation

  1. Daryl Lau
  1. Liver Center, Division of Gastroenterology, Department of, Beth Israel Deaconess Medical Center, Boston, MA, USA
  1. Correspondence to Dr Aysha Aslam, aaslam{at}
  • Accepted 18 May 2018
  • Published 10 June 2018


Reactivation of chronic hepatitis B (CHB) can be associated with significant morbidity and mortality. There are many different causes of hepatitis B reactivation. This case describes an Asian woman with stable CHB presenting with significant hepatitis flare with markedly elevated serum aminotransferases and hepatitis B virus DNA level. The clinical symptoms were subtle with fatigue and vague right upper quadrant tenderness. We ruled out drug-associated hepatotoxicity and screened for common causes of acute hepatitis. Interestingly, she was noted to have reactive anti-hepatitis E virus (HEV) IgM at initial presentation followed by anti-HEV IgG positivity a month later. The serological pattern confirmed the diagnosis of acute hepatitis E. The combination of antiviral therapy for hepatitis B and resolution of acute hepatitis E resulted in normalisation of serum aminotransferases. This case illustrates the importance of taking a careful history and having a high index of suspicion for various aetiologies when evaluating patients with reactivation of CHB.


  • Contributors All authors contributed to the planning and writing the case report. AA and SI helped in writing the initial draft. SSC helped in revising the clinical vignette. AS and AA reviewed and revised the draft. DL contributed in the final revision of the manuscript. All authors approve the current draft for submission and assume responsibility for the accuracy and integrity of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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