{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T13:10:10Z","timestamp":1745759410915,"version":"3.40.4"},"reference-count":19,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,5,20]]},"abstract":"<jats:p>A 59-year-old Caucasian man presented with painless jaundice for 6\u2005weeks. He drank 70\u2005units of alcohol per week. Examination revealed jaundice, spider angiomata and a 3\u2005cm firm hepatomegaly. Initial bloods: bilirubin 152\u2005\u00b5mol\/L, alanine aminotransferase 1484\u2005IU\/L, alkaline phosphatase 130\u2005IU\/L, \u03b3-glutamyl-transpeptidase 1224\u2005IU\/L and International Normalised Ratio 1.1. A standard liver screen was normal, and an abdominal ultrasound\/CT scan suggested cirrhosis, confirmed by liver biopsy on day 5. Hepatitis E virus (HEV) serology on day 6 indicated acute infection. He developed severe hepatic decompensation characterised by worsening jaundice, ascites and variceal bleeding. On day 33 ribavirin 600\u2005mg was initiated though discontinued after 2\u2005weeks on receipt of a negative HEV RNA. At the last follow-up he had recovered, and remains abstinent from alcohol. We describe a case of autochthonously (locally) acquired HEV infection with life-threatening hepatic decompensation in the presence of undiagnosed alcohol-related cirrhosis.<\/jats:p>","DOI":"10.1136\/bcr-2013-202561","type":"journal-article","created":{"date-parts":[[2014,6,5]],"date-time":"2014-06-05T15:19:55Z","timestamp":1401981595000},"page":"bcr2013202561","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Older men with unexplained hepatitis"],"prefix":"10.1136","volume":"2014","author":[{"given":"Kok Haw Jonathan","family":"Lim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Howard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumita","family":"Verma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,6,5]]},"reference":[{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1511.091094"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2893.2007.00858.x"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.3","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181c4096c"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.4","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.78.9.4838-4846.2004"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2007.12.008"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61849-7"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.7","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25505"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.8","doi-asserted-by":"publisher","DOI":"10.1086\/653943"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.9","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.20364"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/jvh.12024","article-title":"Hepatitis E: source and route of infection, clinical manifestations and new developments","volume":"20","author":"Scobie","year":"2013","journal-title":"J Viral Hepat"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2008.01887.x"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.12","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24674"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.13","doi-asserted-by":"publisher","DOI":"10.1086\/655899"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.14","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(08)70255-X"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2009.01.005"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.16","doi-asserted-by":"publisher","DOI":"10.3201\/eid1401.070307"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2007.03504.x"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2011.01.009"},{"key":"2025042705393221000_2014.jun05_1.bcr2013202561.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61030-6"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-202561","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T12:39:45Z","timestamp":1745757585000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-202561"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,6,5]]},"references-count":19,"alternative-id":["10.1136\/bcr-2013-202561"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-202561","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2014,6,5]]}}}