We read with interest the recent article by Miller and colleagues (1) that highlighted a case of bilateral neuralgic amyotrophy in a patient who acquired hepatitis E from livestock. They provided a concise review of the epidemiology of hepatitis E and its acute clinical manifestations.
One important concept that we would like to highlight is that, although hepatitis E is predominantly an acute, self-limited infection with uncommon cases of liver failure, as reported by the authors, chronic hepatitis E infection can occur in patients who are immunosuppressed with substantial morbidity. (2)
Chronic hepatitis E was first reported in 2008 in transplant recipients; most cases have been reported in Europe, although a few have been reported in North America. (3) Although most common in transplant recipients, chronic hepatitis E has also been reported in patients requiring immunosuppression for rheumatological conditions (2) and in patients with hematological conditions....