Fig. 1. Course of aminotransferases in patients with gynecological cancer and HEV infection.

(A) Case 1 developed hepatitis during chemotherapy for treatment of high-risk breast cancer. The HEV viral load showed a remarkable increase during chemotherapy and was cleared rapidly with ribavirin treatment. Seroconversion took place with delay. (B) Case 2 developed hepatitis 2 years after chemotherapy with ongoing bevacicumab therapy for treatment of ovarian cancer. After spontaneous clearance of the HEV infection, ALT levels decreased continuously. (C) Case 3 developed hepatitis 1 year after radiotherapy and ongoing tamoxifen treatment for treatment of breast cancer. Spontaneous clearance of HEV with low viral load and subsequent normalization of ALT occurred.