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Abstract: A 68-year-old grandfather developed malaise, nausea, vomiting, and yellowish staining of the peripheral skin more than 1 month ago, and his symptoms gradually worsened. He was examined in our hospital, and was diagnosed with acute hepatitis E, which is a type of acute hepatitis, by combining the examination indexes and the patient’s medical history. After admission, the patient was given treatment such as liver protection, enzyme lowering, anti-infection and gastric mucosa protection, together with plasma replacement therapy. After treatment, the patient’s jaundice and pruritus were reduced, appetite and energy improved significantly, and liver function completely returned to normal.
Basic information】Male, 68 years old
Disease Type】Acute hepatitis E
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】November 2021
Treatment plan】Symptomatic treatment (ursodeoxycholic acid tablets, adenosylmethionine butanedisulfonate enteric tablets, moxifloxacin hydrochloride tablets, pantoprazole sodium enteric tablets, glycopyrrolate lotion) + plasma replacement therapy
Treatment period】40 days of inpatient treatment, 2 months of follow-up
Treatment effect】Jaundice and pruritus reduced, appetite and energy improved significantly, liver function completely restored to normal
I. Initial interview
The 68-year-old patient, Mr. Li, was very weak at the time of consultation, and was carried into the ward by his family. He was clear, but was depressed and had no strength at all, and the skin and sclera of his eyes were deeply yellow around him. After detailed questioning, the patient was previously fit, had previously smoked and had high blood pressure, had no other specific diseases, and had not consumed large amounts of alcohol for a long time. This time he had been unwell for more than 1 month, and at first he was quite reluctant to come to the clinic. Later, he gradually developed yellow skin staining, with occasional itching, normal stool properties, and yellow urine like strong tea. Recently, his diet and rest were not good and his condition was getting worse. After systematic examination, it showed positive IgM antibody to hepatitis E virus, ultrasound showed diffuse liver changes, blood routine showed increased leukocytes, and combined with the patient’s cough with sputum, the diagnosis of acute hepatitis E with upper respiratory tract infection was finally confirmed.
II. Treatment history
After hospitalization, the patient was placed in gastrointestinal isolation, the room was ventilated with windows open as much as possible to maintain air flow, the family was informed about disinfection, and the shared use of dishes and utensils was avoided. In terms of treatment, the patient was given routine hepatoprotective, anti-yellowing, and anti-infective therapy. Ursodeoxycholic acid tablets and adenosylmethionine butanedisulfate enteric tablets were used to promote bile secretion and have a good anti-yellowing effect. Moxifloxacin hydrochloride tablets were used for anti-infection, and pantoprazole sodium enteric solution tablets were also used to improve the symptoms of gastric discomfort. For skin itching, the family was told to pay attention to skin care and moisturizing, to avoid scratching by the patient, and to use glyburide lotion to stop itching in areas that are not broken. After treatment, the patient’s nausea and abdominal distension improved significantly, but the jaundice continued to deepen and the pruritus did not ease significantly, so the patient’s family was then informed of his condition and plasma replacement therapy was recommended.
III. Treatment effect
Within the first 2 weeks of admission, the patient’s general symptoms improved after liver preservation, anti-yellowness and anti-inflammatory treatment, and the cough was reduced and the coughing sputum disappeared. However, he was still weak, with jaundice and pruritus, and the bilirubin level was still high. After giving a full account of the patient’s condition, plasma replacement therapy was started, which was more effective, and the bilirubin level decreased in a fluctuating manner. When the bilirubin dropped below 100 μmol/L, the patient’s symptoms of jaundice and pruritus were reduced, and his appetite and physical strength improved significantly, and the plasma exchange therapy treatment was terminated. After 40 days of hospitalization, the patient’s total bilirubin level dropped to less than 50 μmol/L. He was discharged home to continue oral liver-protective therapy, and after 2 months of follow-up, the patient’s liver function completely returned to normal.
IV. Notes
We are glad that the patient’s disease improved after treatment, but it should be noted that acute hepatitis E is caused by infection with hepatitis E virus, which can be transmitted through the digestive tract. The common way of infection is through contaminated food and water, so the patient needs digestive tract isolation, avoid sharing utensils and dishes with family members, and protect them. The process of disease treatment and recovery is relatively long. Elderly patients with heavy clinical symptoms combined with cholestasis and itchy skin affecting rest have difficulty in recovery and recover more slowly than young people, therefore, it is necessary to closely observe the indicators of patients to avoid secondary infections during the recovery period, resulting in aggravation of the disease.
V. Personal insight
Acute hepatitis E generally does not require antiviral therapy, and most of them are clinically self-limiting, and the body is usually able to clear the virus automatically without chronicity. The treatment of this patient is mainly based on liver preservation and symptomatic treatment to reduce liver damage and avoid severe hepatitis. The disease is mostly seen in young adults and middle-aged and elderly people, and has a greater impact on elderly patients or pregnant women. Elderly patients have heavy clinical symptoms, long duration of jaundice, slow recovery, and can be combined with complications such as pulmonary infection or biliary tract infection, which can easily develop into severe hepatitis. Therefore, if early treatment is not effective and the patient’s symptoms progressively worsen, be alert to the occurrence of severe hepatitis or even liver failure, and if necessary, artificial liver therapy.