Jaundice in an HIV-positive pregnant woman

History and clinical findings: A 32-year-old woman of African origin in the third trimester of pregnancy was admitted to our hospital with jaundice, dark urine and mild abdominal pain. Symptoms had started one week before admission. During a routine pregnancy check-up six months previously, an HIV infection had been diagnosed and antiretroviral therapy was initiated. The patient had moved from Nigeria to Germany two years before and has not been abroad since then. Investigations: Physical examination revealed marked scleral jaundice and a mild tenderness in the right upper abdominal quadrant. The laboratory tests showed highly elevated levels of liver enzymes and bilirubin. Ultrasonography of, the abdomen indicated normal liver size and parenchyma. Diagnosis, therapy and clinical course: A hepatitis E virus (HEV) infection was identified as the cause of the acute hepatitis. Within the next few weeks the patient recovered spontaneously und a healthy boy was delivered by cesarean section at the expected date. Conclusions: In acute hepatitis during pregnancy concomitant or newly acquired liver diseases such as viral hepatitis should be considered, once ultrasound has excluded obstructive cholestasis or acute cholecystitis.