Hepatitis E during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Hidekazu Ikeuchi; Kana Koinuma; Masao Nakasatomi; Toru Sakairi; Yoriaki Kaneko; Akito Maeshima; Yuichi Yamazaki; Hiroaki Okamoto; Toshihide Mimura; Satoshi Mochida; Yoshihisa Nojima; Keiju Hiromura

doi:10.1155/2018/6873276

Case Reports in Rheumatology (Jan 2018)

Hepatitis E during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Hidekazu Ikeuchi,
Kana Koinuma,
Masao Nakasatomi,
Toru Sakairi,
Yoriaki Kaneko,
Akito Maeshima,
Yuichi Yamazaki,
Hiroaki Okamoto,
Toshihide Mimura,
Satoshi Mochida,
Yoshihisa Nojima,
Keiju Hiromura

Affiliations

Hidekazu Ikeuchi: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
Kana Koinuma: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
Masao Nakasatomi: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
Toru Sakairi: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
Yoriaki Kaneko: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
Akito Maeshima: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan
Yuichi Yamazaki: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan
Hiroaki Okamoto: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
Toshihide Mimura: Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
Satoshi Mochida: Division of Gastroenterology and Hepatology Internal Medicine, Saitama Medical University, Saitama, Japan
Yoshihisa Nojima: Department of Rheumatology and Nephrology, Japan Red Cross Maebashi Hospital, Maebashi, Japan
Keiju Hiromura: Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan

DOI: https://doi.org/10.1155/2018/6873276
Journal volume & issue: Vol. 2018

Abstract

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Hepatitis E is an acute self-limiting disease caused by hepatitis E virus (HEV). Recent reports show that HEV can induce chronic hepatitis or be reactivated in immunocompromised hosts. We report a 63-year-old woman with rheumatoid arthritis (RA) who developed hepatitis E during treatment with tocilizumab. Analysis of serially stocked serum samples confirmed that hepatitis was caused by primary infection with HEV and not by viral reactivation. Her liver function improved after discontinuing tocilizumab and remained within the normal range without reactivation of HEV for >5 years after restarting tocilizumab. We also reviewed the published cases of hepatitis E that developed during RA treatment.

Published in Case Reports in Rheumatology

ISSN: 2090-6889 (Print); 2090-6897 (Online)
Publisher: Wiley
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://onlinelibrary.wiley.com/journal/3857

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