Ribavirin in Acute Hepatitis E Infection in Patients with Gynecological Cancer:A Case Series

Hepatitis E virus infection is usually a self-limited disease.However,during the last years there has been growing evidence for prolonged and chronic infection occurring in patients with immunosuppression.Also patients with malig-nant and rheumatic diseases have been identified to be at risk for chronic hepatitis E.However,their course and prognosis are not well characterized and there have been no reports of hepatitis E virus infection in patients with gynecological cancer.Here,we report three Caucasian females with breast and ovarian cancers presenting with elevation of amino-transferase levels during anticancer treatment.Although only few or no clinical hints suggested hepatitis E virus infection,the diagnosis of hepatitis E virus infection was confirmed by seroconversion,which might occur with some delay,and/or by polymerase chain reaction.While two patients had a self-limited course,the third patient with a high-risk oncological constellation required ribavirin in order to resume chemo-therapy.These cases highlight the need for hepatitis E virus testing in patients with gynecological cancer and elevated aminotransferase levels.Further,these cases show that in selected high-risk patients,ribavirin treatment may be nec-essary based on the decision of a multidisciplinary team.