Dysgeusia in a Patient with Guillain-Barr&amp;eacute; Syndrome Associated with Acute Hepatitis E: A Case Report and Literature Review

Higuchi, Masaaki; Fukae, Jiro; Tsugawa, Jun; Ouma, Shinji; Takahashi, Kazuaki; Mishiro, Shunji; Tsuboi, Yoshio

doi:10.2169/internalmedicine.54.3506

Cited by 17 publications

(8 citation statements)

References 25 publications

(64 reference statements)

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“…According to recent reports, HEV infection appears to be strongly associated with acute pancreatitis, neurological disorders (most commonly manifested as Guillain–Barré syndrome), hemolytic anemia as a result of glucose phosphate dehydrogenase deficiency, severe thrombocytopenia, glomerulonephritis and mixed cryoglobulinemia . In Japan, Guillain–Barré syndrome and peripheral facial palsy have been reported as extrahepatic manifestations related to HEV infection . In our present study, severe thrombocytopenia occurred in one (3 %) of 30 cases with AH‐E.…”

Section: Discussionsupporting

confidence: 61%

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Clinical and virological features of acute hepatitis E in Gunma prefecture, Japan between 2004 and 2015

Yamazaki

Naganuma

Arai³

et al. 2016

Hepatology Research

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Section: Discussionsupporting

confidence: 61%

“…12 In Japan, Guillain-Barré syndrome and peripheral facial palsy have been reported as extrahepatic manifestations related to HEV infection. 27,28 In our present study, severe thrombocytopenia occurred in one (3 %) of 30 cases with AH-E.…”

Section: Discussionsupporting

confidence: 51%

Clinical and virological features of acute hepatitis E in Gunma prefecture, Japan between 2004 and 2015

Yamazaki

Naganuma

Arai³

et al. 2016

Hepatology Research

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“…Among the neuro-muscular manifestations, the commonly reported were neuralgic amyotrophy (n = 102/179; 56.98%) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] and Guillain-Barré syndrome (n = 36/179; 20.11%) [10,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. 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…”

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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“…10,11 An association between infection with hepatitis E virus (HEV) and GBS has been suspected in several case reports and retrospective cohort studies of patients with HEV infection. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In 2013, a prospective case-control study reported positive IgM antibodies against HEV in 11% of patients with GBS in Bangladesh. 30 A second case-control study identified an associated acute HEV infection in 5% of patients with GBS in the Netherlands.…”

mentioning

confidence: 99%

Diagnostic Challenges and Clinical Characteristics of Hepatitis E Virus–Associated Guillain-Barré Syndrome

et al. 2017

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IMPORTANCE Hepatitis E virus (HEV) recently has been shown to be an antecedent infection in Guillain-Barré syndrome (GBS), but the clinical spectrum of HEV-associated GBS is not yet documented, and diagnosing acute HEV infection can be a challenge. OBJECTIVES To determine the prevalence of HEV-associated GBS in a Belgian cohort, study the clinical spectrum of HEV-associated GBS, and discuss difficulties in diagnosing acute HEV infection. DESIGN, SETTING, AND PARTICIPANTS This single-center, retrospective cohort study was conducted between January 1, 2007, and November 1, 2015. All patients with GBS or a GBS variant who presented to the adult neurology department of the University Hospital Leuven were identified via a search of the electronic medical records. Hepatitis E virus IgM and IgG reactivity was determined. In a subgroup, polymerase chain reaction for HEV was performed. MAIN OUTCOMES AND MEASURES Hepatitis E virus IgM and IgG reactivity. RESULTS Of 73 eligible patients (mean [SD] age, 52 [18] years; 29 females and 44 males), 6 (8%) showed positive reactivity on IgM assays for HEV, indicating a possible acute HEV infection. Four of the 6 patients (67%) had increased alanine aminotransferase levels of more than 1.5 times the upper limit of normal, while 4 of 22 patients (18%) with increased alanine aminotransferase levels showed positive reactivity on HEV IgM assays. Serum samples of 2 of 6 patients with positive reactivity on HEV IgM assays also revealed positive test results for cytomegalovirus or Epstein-Barr virus, indicating possible cross-reactivity. Thus, 4 patients (6%) in our cohort had probable acute HEV infection. Two of these patients presented with an infrequent GBS variant. CONCLUSIONS AND RELEVANCE Acute HEV infection was frequently associated with GBS in our cohort. Abnormal alanine aminotransferase levels at admission can indicate the presence of an associated HEV infection. When HEV testing is considered, it is important to test for other infectious agents in parallel, as cross-reactivity can occur. Further studies are required to guide neurologists in their workup of underlying triggers of GBS.

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

Cited by 17 publications

References 25 publications

Clinical and virological features of acute hepatitis E in Gunma prefecture, Japan between 2004 and 2015

Clinical and virological features of acute hepatitis E in Gunma prefecture, Japan between 2004 and 2015

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

Diagnostic Challenges and Clinical Characteristics of Hepatitis E Virus–Associated Guillain-Barré Syndrome

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