Fulminant hepatic failure resulting from hepatitis E and coexistent Wi
lson's disease was diagnosed in a six year old girl six weeks after re
turning from a holiday in India. Wilson's disease was diagnosed on the
basis of histological evidence of hepatocellular copper deposition, c
onfirmed by biochemical estimation of liver copper concentration. Alth
ough severely damaged, the liver was non-cirrhotic. Hepatitis E virus
(HEV) was diagnosed by nested polymerase chain reaction, the specifici
ty of which was confirmed by direct sequencing of amplified DNA. Repli
cation of HEV within the liver at the time of diagnosis was confirmed
by selective amplification of the antigenomic strand of the virus obta
ined from total liver RNA. The patient had an orthotopic liver transpl
antation without recurrence of hepatitis and remains well at 19 months
. Viral excretion, recorded by serial amplifiation of HEV RNA extracte
d from stool samples, persisted for 30 days after liver grafting. Seve
re vitiligo, present preoperatively, dramatically improved after liver
grafting and institution of immunosuppressive treatment. This case su
ggests that viral infection may play a part in the acute decompensatio
n seen in some cases of Wilson's disease.