To the Editor.
—In industrialized countries, it is generally believed that only international travelers face the threat of hepatitis E virus (HEV) infection.1 Recently, Kuwada et al reported that three patients with fulminant hepatitis, all with features of autoimmune hepatitis, had raised IgG anti-HEV antibody titers.2 However, in the 6 months before their hospital admission, none of these patients had traveled to a region of the world where HEV was endemic. This finding prompted us to investigate the presence of HEV antibodies in serum samples from 13 patients with autoimmune—chronic autoimmune hepatitis (AI-CAH) (all positive for antinuclear or anti—smooth muscle antibodies), nine patients with cryptogenic hepatitis (seronegative autoimmune hepatitis), and three patients with primary biliary cirrhosis who were all positive for antimitochondrial antibodies. Serological test results for ongoing or past infection with hepatitis A, B, C, or D virus were negative in all patients. To detect anti-HEV IgG,
Sylvan SPE, Hellstrom UB, Hampl H, Kapprell H, Troonen H. Hepatitis E in Patients With Chronic Autoimmune Liver Disease. JAMA. 1995;273(5):377-378. doi:10.1001/jama.1995.03520290029022