Gauss et al. Journal of Medical Case Reports 2012, 6:334 http://www.jmedicalcasereports.com/content/6/1/334 is often excluded from the differential diagnoses if a pa- tient with acute hepatitis has no history of travel to known HEV-endemic regions. Thus, a considerable pro- portion of autochthonous infections presumably remain undiagnosed. In conclusion, patients with acute or chronic hepatitis of unknown cause during immunosup- pression should be tested for HEV infection. Moreover, chronic courses of HEV must be considered in patients under immunosuppressive therapy. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for re- view by the Editor-in-Chief of this journal. Abbreviations ALT: alanine transaminase; AST: aspartate transaminase; B-CLL: B-cell chronic lymphocytic leukemia; HEV: hepatitis E virus; HIV: human immunodeficiency virus; RNA: ribonucleic acid. Competing interests The authors declare that they have no competing interests. Authors’ contributions AG and PS helped to analyze and interpret the patient data regarding chronic HEV infection and helped to write the manuscript. CF, MHN, CE, WJ, and WS helped to analyze and interpret the patient data regarding chronic HEV infection. JJW helped to analyze and interpret the patient data regarding chronic HEV infection and performed polymerase chain reaction analysis. All authors read and approved the final manuscript. Acknowledgments The authors wish to thank Jasmin Klein, Brigitte Kreuzpaintner, Elke Kreuzpaintner, Anette Rohrhofer, and Sissi Schreder-Meindl for expert technical assistance and Steffen Geis for critically reading the manuscript. Author details 1Department of Internal Medicine IV, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. 2Institute of Medical Microbiology and Hygiene, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. 3Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany. 4Department of Infectious Diseases, Virology, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Received: 30 March 2012 Accepted: 29 August 2012 Published: 2 October 2012 References 1. Haagsma EB, van den Berg AP, Porte RJ, Benne CA, Vennema H, Reimerink JHJ, Koopmans MPG: Chronic hepatitis E virus infection in liver transplant recipients. Liver Transplant 2008, 14:547–553. 2. Kamar N, Selves J, Mansuy JM, Ouezzani L, Péron JM, Guitard J, Cointaut O, Esposito L, Abravanel F, Danjoux M, Durand D, Vinel JP, Izopet J, Rostaing L: Hepatitis E virus and chronic hepatitis in organ-transplant recipients. 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