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Acute hepatitis E with coexistent Plasmodium falciparum infection in a patient with a history of foreign travel

Jeffrey Turner, Chin lye Ch’ng

Am J Case Rep 2008; 9:252-254

ID: 855039

Background: Hepatitis E and malaria are infectious diseases endemic in India and other parts of the world. Both can result in varying degrees of hepatic impairment. There is also an increasing awareness of sporadic hepatitis E within the United Kingdom. This report presents the case of a young gentleman with hepatitis E & Plasmodium falciparum infections. It highlights that these two diseases may coexist in the same patient, complicating their initial presentation. We provide an overview of both hepatitis E and malarial infections, with their impact upon certain patient groups within the UK and abroad.
Case Report: A previously well 17-year-old gentleman was admitted with an intermittent pyrexia after travel from India. Deranged liver function tests were noted following admission, which were initially attributed to a Plasmodium falciparum malaria infection. However his liver function continued to decline despite appropriate treatment of this infection and an improving parasitaemia. After further investigation he was diagnosed with a coexisting acute hepatitis E infection. His clinical condition gradually improved with conservative treatment. He was later discharged home and has remained well at follow up.
Conclusions: Several infectious diseases may coexist in a patient complicating their presentation and management. If a patient does not improve clinically or biochemically with appropriate treatments, then additional diagnoses should be considered. Malaria may be successfully prevented and treated with appropriate drug therapy, reducing mortality rates. Hepatitis E & malaria should always be considered in immigrants or travellers returning from endemic areas presenting with a pyrexia or deranged liver function tests.

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