49-Year-Old Woman Successfully Treated for Cholestasis Following Hepatitis E Infection

A 49-year-old woman, previously in good health, was admitted to the hospital with severe jaundice and cholestasis caused by hepatitis E virus (HEV) infection. After two months of comprehensive treatment including antiviral therapy, plasma transfusions, and corticosteroids, her liver function returned to normal, and her symptoms significantly improved.

Key Information:

- Age: 49

- Gender: Female

- Diagnosis: Hepatitis E with cholestatic liver injury

- Hospital: 988 Hospital of the PLA Joint Logistics Support Force

- Treatment Period: November 2021

- Treatment: Intravenous medications (Compound Glycyrrhizin, Glutathione, Methylprednisolone), plasma therapy

- Outcome: Full recovery of liver function, resolution of cholestasis, and successful discharge after two months

1. Initial Presentation

The patient was transferred to our hospital from a local clinic due to rapidly worsening jaundice, fatigue, dark urine, and skin itching. Upon admission, her total bilirubin level had risen to 400.9 μmol/L, with a prothrombin activity of only 36%. Initial tests also showed elevated alkaline phosphatase and gamma-glutamyl transferase levels, suggesting significant cholestasis. Imaging ruled out obstructive causes such as gallstones or tumors, leading to a diagnosis of cholestatic liver injury.

2. Treatment Process

Immediate care included intravenous liver-protective medications such as compound glycyrrhizin and glutathione. Further testing confirmed acute hepatitis E infection through positive IgM and IgG antibodies. Given the severity of liver damage and ongoing bilirubin elevation, the treatment team introduced corticosteroid therapy with methylprednisolone and plasma infusions to support liver function and coagulation. Within a week, bilirubin levels dropped to 301 μmol/L, and prothrombin activity improved to 46%, indicating a positive response to treatment.

3. Recovery and Outcome

After nearly two months of hospitalization, the patient's bilirubin levels normalized to 28 μmol/L, and prothrombin activity reached 71%. Follow-up imaging showed a normal gallbladder size and no bile duct dilation. Her appetite, energy levels, and sleep improved significantly, allowing for a successful discharge.

4. Post-Discharge Recommendations

While hepatitis E is typically a self-limiting illness, the liver requires time to fully recover after such a severe episode. Patients are advised to:
- Avoid heavy physical labor for at least six months
- Maintain good dietary hygiene and avoid eating at unregulated street vendors
- Refrain from consuming fatty foods and alcohol to prevent gallbladder complications
- Schedule regular follow-up appointments to monitor liver function

5. Clinical Insight

This case highlights the importance of timely diagnosis and aggressive management in severe hepatitis E with cholestatic complications. The patient's infection was likely contracted through contaminated food, a common transmission route for HEV. Practicing safe eating habits, especially avoiding street food, can significantly reduce the risk of such infections. Maintaining a healthy liver through proper diet and lifestyle is essential for long-term wellness.