Volume 150, Issue 2, Pages e3 (February 2016)

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Volume 150, Issue 2, Pages 355-357.e3 (February 2016) Chronic Infection With Camelid Hepatitis E Virus in a Liver Transplant Recipient Who Regularly Consumes Camel Meat and Milk Guan-Huei Lee, Boon-Huan Tan, Esmeralda Chi-Yuan Teo, Seng-Gee Lim, Yock-Young Dan, Aileen Wee, Pauline Poh Kim Aw, Yuan Zhu, Martin Lloyd Hibberd, Chee-Kiat Tan, Michael A. Purdy, Chong-Gee Teo Gastroenterology Volume 150, Issue 2, Pages 355-357.e3 (February 2016) DOI: 10.1053/j.gastro.2015.10.048 Copyright © 2016 AGA Institute Terms and Conditions

Figure 1 Clinicopathologic features. (A) Changes in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Arrows point to times of liver biopsies. (B) Histopathologic changes showing increasing portal and interface hepatitis with portal and septal fibrosis from 17 to 20 months after transplant. Top left: Month 17. Predominant lymphocytic infiltrate (Masson trichrome, 100×). Top right: Month 19. Some portal tracts with mixed portal inflammatory cell infiltrate, focal bile duct damage characterized by cytoplasmic vacuolation and intraepithelial lymphocytes, with no venous endotheliitis (H&E, 200×). Bottom left: Month 20. Ongoing interface hepatitis (H&E, 200×). Bottom right: Month 20. Area of central perivenulitis with hepatocytic drop-out and lymphocytic infiltrate (H&E, 200×). Gastroenterology 2016 150, 355-357.e3DOI: (10.1053/j.gastro.2015.10.048) Copyright © 2016 AGA Institute Terms and Conditions

Figure 2 Phylogenetic analysis of HEV full-length sequences from dromedary camels (genotype 7), compared with that from the patient by the maximum likelihood method. Reported camel HEV sequences and the patient's HEV consensus sequence are highlighted in the yellow box. Additional HEV reference sequences from other hepatitis E genotype sequences from GenBank were included. Gastroenterology 2016 150, 355-357.e3DOI: (10.1053/j.gastro.2015.10.048) Copyright © 2016 AGA Institute Terms and Conditions

Supplementary Figure 1 Phylogenetic analysis of the patient’s HEV open reading frame 2 sequence using 202 orthohepevirus A sequences. Camelid and patient’s sequences are highlighted in the yellow box. Numbers at nodes are bootstrap values from a bootstrap analysis using 1000 replicates. Gastroenterology 2016 150, 355-357.e3DOI: (10.1053/j.gastro.2015.10.048) Copyright © 2016 AGA Institute Terms and Conditions