Hepatitis E differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Hepatitis E must be differentiated from other diseases that cause fever, nausea, vomiting, jaundice, hepatomegaly, icteric sclera, elevated ALT and AST, such as viral hepatitis (caused by other etiologic agents), alcoholic hepatitis, and autoimmune hepatitis.

Differential Diagnosis

Shown below is a table that summarizes the findings that differentiate hepatitis E from other conditions that cause fever, nausea, vomiting, jaundice, hepatomegaly, and icteric sclera.

Disease	Findings
Viral Hepatitis A	Symptoms are similar to the ones of hepatitis E. Similarly, hepatitis A, caused by the hepatitis A virus, produces a self-limited disease, rarely causing complications.
Viral Hepatitis B	Symptoms are similar to the ones of hepatitis E; however, hepatitis B is a life-threatening condition caused by the hepatitis B virus, that may lead to the development of cirrhosis and liver cancer. Serologic testing will help differentiate these two conditions.
Viral Hepatitis C	Symptoms are similar to the ones of hepatitis E. Hepatitis C, caused by the hepatitis C virus, can cause acute and/or chronic hepatitis. Serologic testing will help differentiate these two conditions.
Viral Hepatitis D	Symptoms are similar to the ones of hepatitis E, however, hepatitis D is a serious liver disease caused by infection with the Hepatitis D virus. Hepatitis D only occurs among people who are infected with the hepatitis B virus (HBV). It may complicate into cirrhosis and hepatocellular carcinoma. Serologic testing will help differentiate these two conditions.
Alcoholic Hepatitis	Symptoms are similar to the ones of hepatitis E, however, alcoholic hepatitis is related to the excessive use of alcohol. Alcoholic hepatitis presents more often with ascites. Alcoholic hepatitis often leads to cirrhosis and liver failure, if alcohol use is not decreased. Serologic testing will help differentiate these two conditions. Also laboratory results show ALT<AST in alcoholic hepatitis (inverse from viral hepatitis, which is ALT>AST).
Autoimmune Hepatitis	Autoimmune hepatitis occurs when the body's immune system attacks the hepatocytes. It often affects young females and may present with signs of acute hepatitis or chronic liver disease. Serologic testing will help differentiate these two conditions.