An Unusual Cause of Hepatitis With Nephrotic Syndrome in a Kidney Transplant Recipient

Hepatitis E virus (HEV) infection is an emerging cause of viral hepatitis worldwide. HEV belongs to the family Hepeviridae, which includes 2 genera, namely, Orthohepevirus and Piscihepevirus. The Orthohepevirus genus has 4 species: A, B, C, and D. In humans, a majority of HEV infection is because of variants related to Orthohepevirus species A (HEV-A).1,2 On the other hand, Orthohepevirus species C genotype 1 (HEV-C1), normally found in rats and commonly known as rat HEV, rarely causes human hepatitis.3 Although most HEV infections are self-limiting and asymptomatic, part of the patients can develop fulminant hepatitis and extrahepatic manifestations. In addition, they can become persistent in immunosuppressed individuals.1,4 Although a wide spectrum of extrahepatic manifestations including glomerular injury has been reported during HEV-A infection,5 there have been little data regarding extrahepatic manifestations related to HEV-C1 infection in immunosuppressed patients.3,6 Early diagnosis of glomerulonephritis is important in kidney transplant recipients because it can affect the long-term graft outcome. Herein, we report the first case of biopsy-proven HEVC1- related immune complex glomerulonephritis in a kidney transplant recipient. © 2022 Wolters Kluwer Health. All rights reserved.