Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection: A Case Report and Review

Acute pancreatitis complicating fulminant viral hepatitis has been well recognized; however, acute pancreatitis occurring in nonfulminant hepatitis is very rare. The case presented describes moderate pancreatitis in a young male, manifesting during the course of nonfulminant acute hepatitis E infection. The diagnosis of acute viral hepatitis E was confirmed by serology and reverse transcriptase polymerase chain reaction (RT-PCR) to demonstrate Hepatitis E virus (HEV) RNA in both stool and serum. Patients with acute viral hepatitis presenting with severe abdominal pain should have a diagnosis of acute pancreatitis suspected and appropriate investigations including serum amylase, lipase, biliary ultrasonography and/or contrast-enhanced computed tomography of the abdomen should be undertaken. The identification of this unusual complication of Hepatitis E is important; however, the prognosis for patients with Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection is good, and uncomplicated recovery with conservative treatment is expected. 1. Introduction Background. Patients with acute viral hepatitis who develop severe abdominal pain should be suspected of developing acute pancreatitis and appropriate investigations including serum amylase, lipase, biliary ultrasonography, and contrast-enhanced computed tomography of the abdomen to confirm the diagnosis indicated. The prognosis of patients with acute pancreatitis in the setting of acute viral hepatitis is good and patients recover with conservative treatment [1]. Acute pancreatitis is a common life-threatening disorder characterized by active inflammation of the exocrine pancreas associated with systemic inflammatory response. Clinical examination identifies the etiology of acute pancreatitis in more than 90% of cases with alcohol and cholelithiasis as the leading causes. Among other causes viral infections are well recognized. The viruses most frequently associated with acute pancreatitis are mumps, Coxsackie, rubella, Epstein-Barr virus, cytomegalovirus, and varicella-zoster virus. The association between infectious hepatitis and acute pancreatitis was first reported in 1944 by Linsey. Most cases are related to hepatitis A virus (HAV) and hepatitis B virus (HBV) infections. Furthermore there are a few reports of pancreatitis in acute hepatitis C and in exacerbations of chronic hepatitis B. Hepatitis E virus (HEV) has recently been described as a causative agent of acute pancreatitis mostly in areas of endemic hepatitis E prevalence, but overt pancreatitis has only been reported generally in