Case report: Hepatitis A preceding Guillain–Barré Syndrome

Abstract

A case of acute hepatitis A with Guillain-Barré Syndrome subtype AMAN (acute motor axonal neuropathy) in a 17-year-old male is reported. Serum and cerebrospinal fluid were positive for anti-hepatitis A virus (HAV) IgM, IgG, and IgA. The onset of the syndrome was evident in week 3 of illness. The remarkably high titers of serum anti-HAV IgG appeared unique to a hepatitis A patient with the syndrome. Phylogenetic analysis of the HAV genome detected in the serum and feces revealed genotype IIIA, circulating commonly in Pune, western India.

Longer duration of viremia and unique amino acid substitutions in a hepatitis A virus stain associated with Guillain–Barré syndrome (GBS)

“…It has also been suggested that the detection of plasma HAV RNA after 20 days of illness may predict a prolonged course of the disease [Sagnelli et al, 2003]. The GBS patient of the present study showed persistence of the HAV RNA as monitored up to 126 days by PCR and remarkably high anti-HAV titers [Chitambar et al, 2006]. The longer duration of the HAV RNA in the GBS patient may also thus be indicative of neutralization escape of the virus or a low level of antibodies that could neutralize the virus.…”

“…Fecal specimens were collected during 1992-2004 from patients with acute hepatitis A to study the molecular epidemiology of HAV strains from Pune, western India [Chitambar et al, 2006[Chitambar et al, , 2007. Three specimens collected during these studies were investigated for the conserved and variable features of HAV genomes.…”

“…Fulminant hepatic failure, very rarely persistent infection, renal failure, late recovery, clinical relapse, and chronic hepatitis have been reported as the complications of hepatitis A [Saunders et al, 1979;McDonald et al, 1989;Chio and Bakir, 1992;Glikson et al, 1992;Schiff, 1992;Inoue et al, 1996;Bendre et al, 1999]. In addition, neurological syndromes such as myelitis, peripheral neuropathy, Guillian-Barré syndrome (GBS) have been described in association with hepatitis A [Adams and Asbury, 1980;Owen et al, 1980;Bosch et al, 1983;Pelletier et al, 1985;Chitambar et al, 2006].…”

“…In a recent study [Chitambar et al, 2006], a patient with GBS was classified as a case of subtype acute motor axonal neuropathy (AMAN) on the basis of physical, central nervous system, and electrodiagnostic examinations. The presence of HAV RNA in this case was monitored for 126 days with high anti-HAV IgG level implying a more prolonged immune challenge.…”

Dysgeusia in a Patient with Guillain-Barré Syndrome Associated with Acute Hepatitis E: A Case Report and Literature Review

“…Infections with Campylobacter jejuni, Mycoplasma pneumoniae, Cytomegalovirus and Epstein-Barr virus are each associated with GBS. In addition, it has been reported that hepatitis viruses, including hepatitis A, B and C, are possibly associated with the development of GBS (2)(3)(4). Furthermore, recent reports have suggested that hepatitis E virus (HEV) infection is linked to GBS onset (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”