Case Report: Henoch–Schönlein-like purpura as an unusual presentation of acute hepatitis E virus infection
- 1Unità Operativa Complessa (U.O.C.) Internal Medicine, San Camillo de Lellis Hospital
- 2Laboratory of Virology and Laboratories of Biosafety, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS
- 3Unità Operativa Complessa (U.O.C.) Clinical Pathology, San Camillo Forlanini
Abstract
Introduction: Hepatitis E virus (HEV) infection is increasingly recognized as a cause of extrahepatic manifestations; however, cutaneous purpuric manifestations are exceptionally rare, with only one previous case of Henoch–Schönlein purpura (HSP) reported in association with acute HEV infection.
Methods: This study describes the case of a 91-year-old man admitted with palpable purpura of the lower limbs, associated with jaundice, hypertransaminasemia, and cholestatic abnormalities. Molecular and serological assays were performed.
Results: Serological testing showed anti-HEV IgM and IgG positivity, and HEV RNA was detected in plasma at a viral load of 15,002 IU/mL. The patient reported consumption of wild-boar meat in the month preceding symptom onset. The purpura resolved spontaneously approximately 10 days after onset, and liver parameters progressively improved, with HEV RNA becoming undetectable at follow-up. Phylogenetic analysis of the patient-derived sequence identified the strain as HEV genotype 3f, belonging to the 3f2 subcluster. The patient-derived sequence showed similarity with European HEV-3f/3f2 human strains and with swine and wild boar strains, supporting a likely zoonotic food-borne origin. Plasma interleukin-6 (IL-6) was elevated at admission during the purpuric manifestation.
Discussion: To our knowledge, this is the first Italian report of an HSP-like purpura temporally associated with acute HEV genotype 3f infection. This case highlights that acute HEV infection may be considered in the differential diagnosis of patients presenting with palpable purpura, while emphasizing the exceptional rarity of this manifestation.
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BibTeX
@article{moronti2026case,
title = {{Case Report: Henoch–Schönlein-like purpura as an unusual presentation of acute hepatitis E virus infection}},
author = {Veronica Moronti and Verdiana Zulian and Silvia Pauciullo and Martina De Sanctis and Angela Bibbò and Daniela Pietrobono and Simona Talarico and Andreina Gubbiotti and Massimo Scorretti and Luca Moriconi and Anna Rosa Garbuglia},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1937756},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1937756/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Henoch–Schönlein-like purpura as an unusual presentation of acute hepatitis E virus infection
AU - Veronica Moronti
AU - Verdiana Zulian
AU - Silvia Pauciullo
AU - Martina De Sanctis
AU - Angela Bibbò
AU - Daniela Pietrobono
AU - Simona Talarico
AU - Andreina Gubbiotti
AU - Massimo Scorretti
AU - Luca Moriconi
AU - Anna Rosa Garbuglia
PY - 2026
DA - 2026/10/08
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1937756
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1937756/full
AB - Introduction: Hepatitis E virus (HEV) infection is increasingly recognized as a cause of extrahepatic manifestations; however, cutaneous purpuric manifestations are exceptionally rare, with only one previous case of Henoch–Schönlein purpura (HSP) reported in association with acute HEV infection. Methods: This study describes the case of a 91-year-old man admitted with palpable purpura of the lower limbs, associated with jaundice, hypertransaminasemia, and cholestatic abnormalities. Molecular and serological assays were performed. Results: Serological testing showed anti-HEV IgM and IgG positivity, and HEV RNA was detected in plasma at a viral load of 15,002 IU/mL. The patient reported consumption of wild-boar meat in the month preceding symptom onset. The purpura resolved spontaneously approximately 10 days after onset, and liver parameters progressively improved, with HEV RNA becoming undetectable at follow-up. Phylogenetic analysis of the patient-derived sequence identified the strain as HEV genotype 3f, belonging to the 3f2 subcluster. The patient-derived sequence showed similarity with European HEV-3f/3f2 human strains and with swine and wild boar strains, supporting a likely zoonotic food-borne origin. Plasma interleukin-6 (IL-6) was elevated at admission during the purpuric manifestation. Discussion: To our knowledge, this is the first Italian report of an HSP-like purpura temporally associated with acute HEV genotype 3f infection. This case highlights that acute HEV infection may be considered in the differential diagnosis of patients presenting with palpable purpura, while emphasizing the exceptional rarity of this manifestation.
SN - 1664-3224
ER -