Acute ‘Olympic’ Hepatitis: A Medical Experience from the Vancouver 2010 Games

Authors

  • Pamela Verma

Abstract

A visitor from Asia, visiting for the Opening Ceremonies of the 2010 Vancouver Olympic Games, who was in his mid 50s, was referred to the on-call Olympic Gastroenterology Specialist Group with acute hepatitis. The patient had no previous history of alcoholism or Hepatitis B or C infection. On presentation, he was found deeply jaundiced without any clinical encephalopathy and stigmata of chronic liver disease. Initial laboratory investigations revealed acute liver failure which was complicated by renal impairment.  He was admitted to the Vancouver General Hospital. His immediate prognosis was considered significant enough to result in referral to the liver transplant services. With increasing global travel to Vancouver, it is apparent that acute HEV will need to be considered in the differential diagnosis of any patient with acute liver failure. Appropriate screening tests included Hepatitis A, B and C viral serology, metabolic and autoimmune markers, which were all negative. The initial history suggested hepatotoxicity from Traditional Chinese Medicines; however after a careful review via an interpreter, it was clear that the herbal medications were consumed after the patient became ill.  A liver biopsy was performed which revealed features consistent with acute Hepatitis E (HEV).  Subsequent positive viral serology for anti-HEV IgM then positive confirmed a diagnosis of acute HEV.  After clinical review of the incubation time of acute HEV and the timeline of the patient’s visit to Vancouver, it was apparent that the infection was acquired in Asia. The patient’s liver function improved with conservative treatment and he was able to return home. 

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Published

2011-06-09

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Section

Case and Elective Reports