Screening of hepatitis E virus infection should be included in the current diagnostic scale for drug-induced liver injury in Japan

Abstract

We compared the clinical features and laboratory data of 13 cases with acute hepatitis E and 61 cases with drug-induced liver injury (DILI) in our hospital. Out of 13 hepatitis E cases, 12 had no history of eating or undercooked raw meat/viscera and remained unknown for the origin and route of hepatitis E virus (HEV) infection. More than half of acute hepatitis E and DILI did not exhibit jaundice during the clinical course. All 13 cases of acute hepatitis E had a high score of ≥5 points by the DDW-J 2004 scale. Without HEV screening, eight cases of acute hepatitis E might have been misdiagnosed as DILI. The DDW-J 2004 scoring scale, current diagnostic scale for DILI, cannot discriminate acute hepatitis E cases from DILI cases because the scoring scale has no support for HEV infection. We propose that HEV-IgA test should be included in the current diagnostic scale for drug-induced liver injury for differential diagnosis of acute HEV infection to provide more accurate diagnosis of DILI in Japan.