Acute hepatitis E virus infection presenting as a prolonged cholestatic jaundice

Hepatitis E virus (HEV) is an enteric virus that usually causes a self-reso lving hepatitis: although, it may be fatal, especially in pregnant women. A lthough HEV is endemic in Israel, there have been no recent local outbreaks . We report the case of a 70-year-old man who presented with painless jaund ice. Ultrasound and abdominal computed tomography scan revealed gallstones, with no evidence of cholecystitis and no dilatation of the intra- or extra hepatic bile ducts. An open cholecystectomy was performed with intraoperati ve cholangiography. There was no evidence of choledocholithiasis. A subsequ ent endoscopic retrograde cholangiopancreatography was normal, His bilirubi n level subsequently increased to a maximum of 25 mg/dL. and his gamma-glut amyltransferase level reached 1,400 U/L. There was no evidence of any autoi mmune or metabolic disease, and routine viral serology was normal except fo r immunoglobulin G to hepatitis A virus. A liver biopsy revealed an acute c holestatic picture. The jaundice resolved slowly after a period of 6 months . Hepatitis E virus RNA was isolated from the acute-phase serum and was not detectable in the convalescent serum. This case is a unique example of chr onic cholestatic jaundice that we think is caused by acute HEV infection.