This case report describes a 91-year-old man with Henoch-Schönlein-like palpable purpura temporally associated with acute HEV genotype 3f infection, likely acquired from wild-boar meat, suggesting acute HEV infection may be considered in the differential diagnosis of palpable purpura while emphasizing the exceptional rarity of this manifestation.
A 91-year-old man presented with palpable purpura of the lower limbs accompanied by jaundice, hypertransaminasemia, and cholestatic abnormalities, and was diagnosed with acute HEV infection.
The purpura resolved spontaneously and liver parameters improved, with HEV RNA becoming undetectable at follow-up.
Phylogenetic analysis identified the patient's HEV strain as genotype 3f, subcluster 3f2.
The infection was likely a zoonotic food-borne infection linked to wild-boar meat consumption.
Plasma interleukin-6 (IL-6) was elevated at admission during the purpuric manifestation.
This is reported as the first Italian case of HSP-like purpura temporally associated with acute HEV genotype 3f infection, and only one prior HSP case with acute HEV has been reported.
Acute HEV infection may be considered in the differential diagnosis of patients presenting with palpable purpura, although the manifestation is exceptionally rare.
This case report describes a 91-year-old man who came to hospital with raised, purplish skin spots on his legs (palpable purpura), together with yellowing of the skin and abnormal liver tests. Testing showed he had an acute hepatitis E virus (HEV) infection. He had eaten wild-boar meat in the month before becoming ill, and genetic analysis showed his virus was genotype 3f, closely resembling strains found in European people, pigs and wild boar. This supports the idea that he caught it from food of animal origin. The skin rash went away on its own after about 10 days, and his liver tests gradually improved. At follow-up the virus could no longer be detected in his blood. An inflammation marker, interleukin-6, was raised when the rash was present, hinting that an immune reaction may have been involved. This research suggests that hepatitis E could be one of the possible causes doctors consider when someone has this type of rash, especially alongside liver abnormalities. However, this is a single case, so it cannot prove HEV caused the rash, and the authors stress that such a presentation is exceptionally rare.
Moronti V, Zulian V, Pauciullo S, De Sanctis M, Bibbò A, Pietrobono D, et al.. (2026). Case Report: Henoch-Schönlein-like purpura as an unusual presentation of acute hepatitis E virus infection.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1937756