Abstract：
Acute hepatitis E, one of the causes of acute liver injury, has been increasingly diagnosed in developed countries in recent years. Misdiagnosis of acute hepatitis E virus (HEV) infection as drug-induced liver injury (DILI) may lead to discontinuation of effective chemotherapy. Thus, viral hepatitis, including hepatitis E, must be ruled out in the diagnosis of DILI. A 78-year-old woman with lung adenocarcinoma and multiple bone metastases received maintenance therapy with pemetrexed + pembrolizumab for a year. Increased aspartate aminotransferase and alanine aminotransferase levels, indicating acute liver injury, were observed. Initially, DILI was suspected, and she was given medications to lower the levels of hepatic enzymes. She was later admitted to the hospital with the chief complaint of general malaise and anorexia. Serum aspartate aminotransferase and alanine aminotransferase levels were markedly elevated (381 and 854 U/L, respectively). Acute HEV infection was diagnosed based on the detection of serum HEV immunoglobulin A antibodies. The patient received liver support therapy, and the serum hepatic enzymes recovered to normal levels. Chemotherapy was resumed without any subsequent relapse of hepatic enzyme elevation. When DILI is suspected during chemotherapy, exclusion of viral hepatitis is mandatory, which can be achieved by measuring markers of hepatitis viruses, including HEV, and examining the patient\'s detailed medical history.
摘要：
急性戊型肝炎,急性肝损伤的原因之一，近年来，在发达国家越来越多地得到诊断。急性戊型肝炎病毒（HEV）感染误诊为药物性肝损伤（DILI）可能导致有效化疗的中断。因此，病毒性肝炎,包括戊型肝炎,在DILI的诊断中必须排除。一名78岁的女性患有肺腺癌和多发性骨转移，接受培美曲塞+派姆单抗维持治疗一年。天冬氨酸转氨酶和丙氨酸转氨酶水平升高，提示急性肝损伤，被观察到。最初，DILI被怀疑,她接受了降低肝酶水平的药物治疗。她后来因全身不适和厌食症而入院。血清天冬氨酸转氨酶和丙氨酸转氨酶水平显著升高(381和854U/L,分别)。根据血清HEV免疫球蛋白A抗体检测诊断急性HEV感染。患者接受肝脏支持治疗,血清肝酶恢复到正常水平。恢复化疗，随后肝酶升高没有任何复发。当在化疗期间怀疑DILI时，排除病毒性肝炎是强制性的，这可以通过测量肝炎病毒的标志物来实现，包括HEV,并检查病人的详细病史。
