{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:13:43Z","timestamp":1793060023631,"version":"4.5.0"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Objectives: Hepatitis E virus (HEV) infection is a pandemic with regional outbreaks, including in industrialized countries. HEV infection is usually self-limiting but can progress to chronic hepatitis E in transplant recipients and HIV-infected patients. Whether other immunocompromised hosts, including rheumatology and internal medicine patients, are at risk of developing chronic HEV infection is unclear. Methods: We conducted a retrospective European multicenter cohort study involving 21 rheumatology and internal medicine patients with HEV infection between April 2014 and April 2016. The underlying diseases included rheumatoid arthritis (n = 5), psoriatic arthritis (n = 4), other variants of chronic arthritis (n = 4), primary immunodeficiency (n = 3), systemic granulomatosis (n = 2), lupus erythematosus (n = 1), Erdheim\u2013Chester disease (n = 1), and retroperitoneal fibrosis (n = 1). Results: HEV infection lasting longer than 3 months was observed in seven (33%) patients, including two (40%) patients with rheumatoid arthritis, three (100%) patients with primary immunodeficiency, one (100%) patient with retroperitoneal fibrosis and one (100%) patient with systemic granulomatosis. Patients with HEV infection lasting longer than 3 months were treated with methotrexate without corticosteroids (n = 2), mycophenolate mofetil\/prednisone (n = 1), and sirolimus\/prednisone (n = 1). Overall, 8\/21 (38%) and 11\/21 (52%) patients cleared HEV with and without ribavirin treatment, respectively. One patient experienced an HEV relapse after initially successful ribavirin therapy. One patient (5%) was lost to follow-up, and no patients died from hepatic complications. Conclusion: Rheumatology and internal medicine patients, including patients treated with methotrexate without corticosteroids, are at risk of developing chronic HEV infection. Rheumatology and internal medicine patients with abnormal liver tests should be screened for HEV infection.<\/jats:p>","DOI":"10.3390\/v11020186","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T11:26:14Z","timestamp":1550834774000},"page":"186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Sven","family":"Pischke","sequence":"first","affiliation":[{"name":"Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"German Centre for Infection Research (DZIF), Hamburg partner site, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marie","family":"Peron","sequence":"additional","affiliation":[{"name":"Service d\u2019h\u00e9pato-gastroent\u00e9rologie, H\u00f4pital Purpan CHU Toulouse, Universit\u00e9 Paul Sabatier III, 31000 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"von Wulffen","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2839-5174","authenticated-orcid":false,"given":"Johann","family":"von Felden","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"H\u00f6ner zu Siederdissen","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Fournier","sequence":"additional","affiliation":[{"name":"Service d\u2019h\u00e9pato-gastroent\u00e9rologie, H\u00f4pital Purpan CHU Toulouse, Universit\u00e9 Paul Sabatier III, 31000 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"L\u00fctgehetmann","sequence":"additional","affiliation":[{"name":"German Centre for Infection Research (DZIF), Hamburg partner site, 20246 Hamburg, Germany"},{"name":"Microbiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8716-3894","authenticated-orcid":false,"given":"Christoph","family":"Iking-Konert","sequence":"additional","affiliation":[{"name":"Rheumatology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Bettinger","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany"},{"name":"Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6943-6756","authenticated-orcid":false,"given":"Gabriella","family":"Par","sequence":"additional","affiliation":[{"name":"Clinical Centre, First Department of Medicine, University of P\u00e9cs, H-7622 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Thimme","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Cantagrel","sequence":"additional","affiliation":[{"name":"Service d\u2019h\u00e9pato-gastroent\u00e9rologie, H\u00f4pital Purpan CHU Toulouse, Universit\u00e9 Paul Sabatier III, 31000 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansgar W.","family":"Lohse","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"German Centre for Infection Research (DZIF), Hamburg partner site, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"German Centre for Infection Research (DZIF), Hamburg partner site, 20246 Hamburg, Germany"},{"name":"Gastroenterology, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"de Man","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Erasmus MC Medical Center Rotterdam, 3062 PA Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2219-9201","authenticated-orcid":false,"given":"Vincent","family":"Mallet","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Descartes, Assistance Publique\u2014H\u00f4pitaux de Paris (AP\u2014HP), H\u00f4pital Cochin, Hepatology Service, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale unit\u00e9 1223, Institut Pasteur, 75006 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1002\/hep.28436","article-title":"A nationwide survey of 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Case Rep."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/11\/2\/186\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:34:03Z","timestamp":1760186043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/11\/2\/186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,22]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["v11020186"],"URL":"https:\/\/doi.org\/10.3390\/v11020186","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,22]]}}}