Case reportNeuralgic amyotrophy associated with hepatitis E virus
Introduction
Neuralgic amyotrophy (NA) is a form of peripheral neuropathy characterised by neuropathic pain and patchy paresis of the upper limbs, usually involving the upper and middle trunks of the brachial plexus. NA typically manifests initially with pain, with subsequent weakness and atrophy of affected muscles. The incidence of idiopathic NA is 2–3/100,000 per year [1]. First described in the nineteenth century, the publication of the first large case series of 136 patients in 1948 coined its eponymous name, Parsonage–Turner syndrome [2]. Precipitating causes of NA include trauma, surgery, inoculations and various infections, although the pathophysiology behind its development remains unclear.
Hepatitis E is an enterically transmitted virus prominent in the developing world, responsible for both sporadic and endemic hepatitis. It was first characterised in patients with serological markers distinct from hepatitis A or B virus, and became known as non-A, non-B hepatitis [3]. The course of illness is usually self-limiting with no reports of chronic hepatitis E infection. In addition, to our knowledge, there has not been any documented neurological complications or peripheral neuropathy arising subsequent to hepatitis E infection.
Section snippets
Case report
A 53-year-old ecologist presented to the Emergency Department with onset of bilateral shoulder pain radiating to the chest. He had returned from a trip to Equador 4 weeks prior to presentation. He had no past medical history, previous surgery to the shoulder or neck or history or trauma. He did not have any flu-like or coryzal symptoms. He reported minimal alcoholic intake. Systemic examination including neurological examination was normal. Investigations revealed no evidence of systemic
Discussion
This patient had NA because of his clinical presentation with a characteristic patchy peripheral neuropathy involving the brachial plexus that was confirmed with electrophysiological testing. The diagnosis of NA is based on clinical findings and is supported by nerve conduction studies and electromyography. However, factors such as the time of testing, the patchy distribution and varying degree of neural damage may influence the results and thus be inconclusive or yield false-negative results
Conflicts of interest
None to declare.
Acknowledgement
None.
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Cited by (63)
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2015, Journal of Clinical VirologyCitation Excerpt :No symptomatic HEV cases were identified in close contacts. Twenty-one cases describing neuralgic amyotrophy associated with HEV were found in our literature search [11,12,16,18–29]. Including our patients, we count a total of 26 cases reports (Table 1).
Significance of hepatitis E virus infection in HIV-infected patients: A challenging issue
2015, Asian Pacific Journal of Tropical Disease
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