S3230 A Case of Acute Hepatitis E Infection Associated With Deer Meat in the U.S.

Introduction: The seroprevalence rate of hepatitis E virus (HEV)infection in the United States (U.S.) is only 6% (95% CI 5.1-6.9%). Most cases of HEV have been reported in travelers from endemic countries. Fecal oral transmission is the usual route and associated with genotypes 1 and 2. Pregnant women and the immunocompromised are especially vulnerable. Zoonotic cases of HEV acquired from the consumption of swine liver or other organ meats, are more common outside the U.S. and associated with HEV 3 and 4. Multiple potential animal reservoirs have been identified, but few cases of zoonotic infection have been confirmed within the U.S. Case Description/Methods: A 53-year-old female with past medical history significant for depression and hyperlipidemia presented with a one-week history of worsening epigastric pain, nausea and vomiting, fatigue, and intermittent fevers after butchering several deer. She smoked 10 cigarettes/day regularly, and only drank occasionally. She had no known allergies. Her home medications included aspirin, citalopram, atorvastatin, and melatonin. She was alert and oriented with a labile affect. She had mild scleral icterus. Her abdomen was soft with epigastric tenderness. There was no hepatomegaly, spider nevi, telangiectasia, or caput medusa. Her laboratory tests revealed a mixed but mostly hepatocellular injury pattern with an ALT 2365 U/L (0-35 U/L), AST 1107 U/L (0-35 U/L), alkaline phosphatase 262 U/L (36-92 U/L), and total bilirubin 2.6 mg/dl (0.3-1.2 mg/dl). Hepatitis B, C, and A serologies were negative. Anti-smooth muscle antibody, liver-kidney-microsomal-1 antibody, anti-mitochondria antibody, and hemochromatosis screen were negative. Abdominal ultrasound did not show any biliary or pancreatic abnormalities. Further testing for Hepatitis E, IgM and IgG were positive. A diagnosis of acute HEV infection was made. She was managed conservatively with intravenous fluids and analgesics without antiviral therapy. She denied symptoms and her hepatic panel returned to normal at one month’s follow up. Discussion: This case confirms deer as a vector for the transmission of HEV to humans in the U.S. We note the proximity of Wisconsin to Canada. While the seroprevalence of HEV among deer in Canada has been estimated to range from 3.2-8.8%, the HEV RNA itself has not been detected in the animals. A prior report of multiple HEV infections from the consumption of raw deer meat has been reported in Japan.

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