# Co‐Infection With Hepatitis E Virus and SARS‐CoV‐2 in a Lymphoma Patient

## TL;DR

A lymphoma patient had a rare co-infection with Hepatitis E virus and SARS-CoV-2, highlighting risks for immunocompromised individuals.

## Contribution

Reports a rare case of HEV and SARS-CoV-2 co-infection in an immunocompromised patient.

## Key findings

- The patient had chronic hepatitis E at cirrhosis stage and was infected with the SARS-CoV-2 Delta variant.
- Ribavirin temporarily reduced HEV RNA in plasma when immunosuppressive therapy was interrupted.
- Coinfections may worsen liver outcomes in immunocompromised individuals.

## Abstract

Hepatitis E virus (HEV) and SARS‐CoV‐2 are both ubiquitous worldwide. We report here a rare case of HEV and SARS‐CoV‐2 coinfection. HEV and SARS‐CoV‐2 diagnoses were carried out by qPCR. Virus genotyping was performed by analyzing partial or near full‐length genomes obtained by next‐generation sequencing from plasma or nasopharyngeal specimens, respectively. The case was a lymphoma patient admitted to hospital for oxygen‐requiring qPCR‐documented Covid‐19. SARS‐CoV‐2 was a Delta variant. Reevaluation of a liver cytolysis documented 1 year earlier revealed concurrent chronic hepatitis E at cirrhosis stage. HEV genotype was 3c. Ribavirin was administered, but to date only temporarily led to HEV RNA undetectability in plasma when combined with immunosuppressive therapy interruption. This case and the three previous cases of coinfection with HEV and SARS‐CoV‐2 point out the possible deleterious effect of SARS‐CoV‐2 on the liver and the increased risk of such concurrent infections in immunocompromized patients.