Acute hepatitis E infection as a cause of unexplained neurological symptoms

Blayney, Lauren; Morrish, Paul

doi:10.1136/bcr-2018-224236

Cited by 3 publications

(3 citation statements)

References 20 publications

(18 reference statements)

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“…The other rarer neurological manifestations that were reported include mononeuritis multiplex [10], encephalitis [11,13,39,41], cerebral ischemia [11,39], myasthenia gravis [42], polyneuromyopathy [24,43], meningo-radiculitis [10,44], epilepsy [11], encephalopathy [45], facial nerve palsy [11,46,47], encephalitic parkinsonism [48], transverse myelitis [49], peripheral neuropathy [24,39,50], vestibular neuritis [24], small fiber neuropathy [24], Myositis [51], and certain non-specific neurological symptoms like myalgias, joint pains, etc. [52,53] which are summarized in Table 1. CR: case report; RS: retrospective study; CC: Case-Control study; CS: Case Series; CSS: cross-sectional study; * one patient each was reported to have Miller-Fiser variant of Guillain-Barré syndrome; # report of a patient with anterior interosseous mono-neuropathy.…”

Section: Neurological and Musculoskeletal Manifestationsmentioning

confidence: 99%

A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection

et al. 2020

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Hepatitis E virus (HEV) is a non-enveloped, positive-sense, single-stranded RNA icosahedral virus belongs to the genus Orthohepevirus within the Hepeviridae family. HEV infection can be asymptomatic, or it can cause icteric or fulminant hepatitis. Off late, there have been a number of publications reporting the extra-hepatic manifestations of HEV infection, and this systematic review is aimed at summarizing the available evidence in this regard. Two independent investigators searched PubMed, PubMed Central and Embase databases using the search string “(((hepatitis E) AND (Extrahepatic OR Extra-Hepatic))) OR ((Hepatitis E) AND (Neurology OR Cardiology OR Respiratory OR Lung OR Gastrointestinal OR musculoskeletal OR immunology OR pulmonary)) Filters: Abstract availability, English language, and Human studies”. The extra-hepatic manifestations reported in each of the selected articles were classified and reported as neurological, cardiovascular, and hematological and miscellaneous manifestations. The total number of various manifestations reported in our study were n = 324. These include neurological manifestations (n = 178/324 (54.94%)), cardiovascular and hematological manifestations (n = 113/324 (34.88%)), gastro-intestinal/pancreaticobiliary manifestations (n = 24/324 (7.41%)) and other rarer manifestations involving systems such as renal (n = 4/324; 1.24%), endocrine (n = 1/324; 0.31%), dermatology (n = 1/324; 0.31%), respiratory (n = 1/324; 0.31%), muscular (n = 1/324; 0.31%) and immune system (n = 1/324; 0.31%). Thus, HEV can have extra-hepatic manifestations affecting any system of the human body. Further research is needed to elucidate the underlying pathophysiological manifestations of these extra-hepatic manifestations and to prove causal association with HEV.

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Section: Neurological and Musculoskeletal Manifestationsmentioning

confidence: 99%

A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection

et al. 2020

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“…Furthermore, it is believed that regional differences in clinical presentation as well as genotypes are relevant and should be considered when diagnosing neurological manifestations of HEV [ 26 ]. Due to the great heterogeneity of clinical phenotypes and the largely unknown pathomechanism, it is important to consider HEV in unusual neurological cases [ 27 ] in addition to the most common neurological manifestations GBS and neuralgic amyotrophy [ 6 – 8 , 12 , 16 , 21 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological manifestation of HEV infection: still a rare disease entity?

Wiesenfarth,

Stamminger,

Zizer

et al. 2023

J Neurol

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Hepatitis E virus (HEV) infection is the most common form of viral hepatitis and is reported to cause neurological manifestation in up to 30% of diagnosed infections. We evaluated the medical reports of all patients (n = 29,994) who were discharged from the Department of Neurology of Ulm University between 01.01.2015 and 30.09.2022 to detect neurological manifestations of HEV. In addition, we retrospectively analyzed the serum samples of n = 99 patients representing different neurological diseases possibly related to HEV for anti-HEV-IgM and anti-HEV-IgG. At the time of discharge from hospital, the etiology of neurological symptoms in these patients was unclear. Overall, five cases of extrahepatic neurological manifestation of HEV (defined as anti-HEV-IgM and HEV-IgG positive) could be detected. An increase of both, anti-IgM- and anti-IgG-serum levels was significantly more common in neuralgic amyotrophy/plexus neuritis/radiculitis than in AIDP/CIDP (P = 0.01), meningitis/encephalitis (P = 0.02), idiopathic peripheral facial paralysis (P = 0.02) and tension headache (P = 0.02). In 15% (n = 15 out of 99) of retrospectively analyzed serum samples, conspicuous positive anti-HEV-IgG levels were detected. This finding was most common in AIDP/CIDP. In conclusion, results of this study indicate neurological manifestation of HEV to be a rare but still underestimated course of disease, occurring at any age and gender. Therefore, testing for HEV should be considered in patients with neurological symptoms of unknown origin, especially in those with neuralgic amyotrophy/plexus neuritis.

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“…1 Treatment is usually supportive, although ribavirin has been used in severe illness or in the immunosuppressed 9 who may experience chronic infection. 10 The commonest reported extrahepatic manifestations reported are neurological, occurring in 7.5% of individuals with acute hepatitis E. 11 Rash has been reported in around 3% in some European series 12,13 and cryoglobulinaemia has also been reported. 14 We note one similar case report in the Lancet in 2013, describing a woman presenting with a widespread, maculopapular rash and transaminitis.…”

Section: Discussionmentioning

confidence: 99%

Widespread rash as initial presentation of acute hepatitis E in a woman with well-controlled HIV

Pringle

Halsema

2021

Int J STD AIDS

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Sporadic, acute hepatitis E is increasingly common in the United Kingdom, associated with travel or locally acquired. A 45-year-old woman with well-controlled HIV presented with a widespread, polymorphic rash and transaminitis. Acute genotype 3 hepatitis E infection was confirmed and resolved without intervention. A review of the literature reveals a number of atypical presentations of acute autochthonous hepatitis E. Clinicians should consider testing for hepatitis E in the presence of nonspecific symptoms and deranged liver function tests.

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Acute hepatitis E infection as a cause of unexplained neurological symptoms

Cited by 3 publications

References 20 publications

A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection

A Systematic Review of the Extra-Hepatic Manifestations of Hepatitis E Virus Infection

Neurological manifestation of HEV infection: still a rare disease entity?

Widespread rash as initial presentation of acute hepatitis E in a woman with well-controlled HIV

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