Marta Ólafsdóttir¹

Arthur Löve²

Jón Gunnlaugur Jónasson³

Einar Stefán Björnsson⁴

¹Department of internal medicine, ²Department of Virology, ³Department of pathology, ⁴Department of gastroenterology, Landspítali University Hospital Reykjavík, Iceland.

Correspondence: Marta Ólafsdóttir, martaolafs@gmail.com

Key words: hepatitis E, viral hepatitis, myalgia, case report.

Hepatitis E is a viral disease that is usually transmitted through contaminated drinking water and most often causes a self-limiting infection that does not require specific treatment. It is common in India and has caused outbreaks in Asia, Africa and Mexico but has very rarely been diagnosed in Iceland. We describe two cases of hepatitis E diagnosed in Iceland in the last year.

Table I. Serum liver test measurements for patient 1 during follow-up. Day 1 is the day of arrival at Landspitali. AST = Aspartate transaminase, ALT = Alanine transaminase, GGT = Gamma-glutamyl transferase, Bil = Bilirubin, ALP = Alkaline phosphatase, Hg = Health clinic, Lsp = Landspítali

Table II. Serum liver test measurements for patient 2 during follow-up. Day 1 is the day of arrival at Landspitali.

Figure 1. Liver tissue with acute hepatitis. Liver cells show degenaritve changes. In the center and left part of the image inflammatory cells (with small dark nuclei) are prominent among the liver cells. In the bottom center of the image a dead liver cell (Councilman‘s body) is visible, reddish in colour surrounded by a pale circle. H/E stain, magnification =x200."

Figure 2. Liver tissue with acute hepatitis. The liver cells vary greatly in size, some are distended with pale cytoplasm. Among the liver cells different types of inflammatory cells can be seen. In the lower left corner of the image a dead liver cell is visible. H/E stain, magnification =x400."