Supplementary Material for: Ribavirin Treatment in Acute HEV-Induced Liver Injury in a Healthy U.S. Female: A Case Report

Introduction
Hepatitis E virus (HEV) is a global cause of acute viral hepatitis, for which there is currently no FDA-approved medication. This case report describes a unique instance of a healthy U.S. female presenting with acute HEV, who was treated with ribavirin to address her acute liver injury.
Case Presentation
A 36-year-old U.S. female, non-pregnant, without liver disease, developed nonspecific symptoms post-travel to Indonesia, leading to acute liver injury with concern for failure. Liver biopsy showed severe hepatocellular necrosis (> 50%) with mixed infiltrate; HEV PCR was positive (93,700,000 IU/ml). After risk-benefit analysis, Ribavirin treatment resolved symptoms and normalized biomarkers in a month, avoiding emergency transplantation.
Conclusion
Consider HEV infection in acute liver injury cases in the U.S., especially with exposure risks. Ribavirin's role in acute cases warrants further study, potentially averting major morbidity and mortality