Two Uncommon Causes of Guillain-Barré Syndrome: Hepatitis E and Japanese Encephalitis

Abstract

We are presenting two cases of Guillain-Barré syndrome where it is preceded by hepatitis E virus (HEV) and Japanese encephalitis virus (JEV) infection, respectively. Our first case is a forty-three-year-old nondiabetic, nonhypertensive female who was initially diagnosed with acute HEV induced viral hepatitis and subsequently developed acute onset ascending quadriparesis with lower motor neuron type of bilateral facial nerve palsies and respiratory failure. Second patient was a 14-year-old young male who presented with meningoencephalitis with acute onset symmetric flaccid paraparesis. After thorough investigations it was revealed as a case of Japanese encephalitis. Our idea of reporting these two cases is to make ourselves aware about this potential complication of these two common infections.

A Retrospective Study of the Clinical Characteristics of Japanese Encephalitis in Adults

“…Severe cases may be associated with pulmonary edema and respiratory failure [9]. Some patients have other symptoms after being infected with JEV, such as acute myelitis caused by transverse spinal cord injury [10] and Guillain-Barré syndrome caused by nerve root damage [11]. The patients in the present study all had acute onset, with fever and headache as the first symptoms; the disease then progressed rapidly, with high fever and unconsciousness, including five cases with respiratory failure.…”

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

“…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…”

An uncommon complication of Listeria monocytogenes infection: Polyradiculoneuritis following Listeria meningoencephalitis

“…In this case, positive anti-HEV IgM antibodies were detected suggesting a recent infection. However, in all cases of GBS related to a hepatitis E infection, ALT and AST levels were at least 1.5 times above the upper limit which is not the case of this patient [ [9] , [10] ]. The differential diagnosis of neuralgic amyotrophy associated with HEV (Parsonage-Turner syndrome) was not considered regarding the absence of pain and amyotrophy.…”