Severe bilateral amyotrophic neuralgia associated with major dysphagia secondary to acute hepatitis E [v2; ref status: indexed, http://f1000r.es/2q8]

• Main Authors: Xavier Moisset, Nicolas Vitello, Elodie Bicilli, Romain Courtin, Anna Ferrier, Frederic Taithe, Clément Lahaye, Ali Ait Hssain, Cyril Garrouste, Clavelou Pierre
• Format: Article
• Language: English
• Published: F1000 Research Ltd 2014-01-01
• Series: F1000Research
• Subjects: Musculoskeletal Pain & Analgesia; Neuromuscular Diseases; Viral Infections (without HIV)
• Online Access: http://f1000research.com/articles/2-259/v2

Introduction: Several acute neurological syndromes can be triggered by immune events. Hepatitis E virus (HEV), an emerging infectious disease, can be one of these triggers. Case report: We report the case of a 36-year-old man that presented nausea and a dull abdominal pain for a week and then felt an acute neuralgic pain involving both shoulders that lasted for 8 to 10 hours. Immediately after, the patient presented a severe bilateral muscular weakness of the proximal part of both upper limbs, corresponding to an amyotrophic neuralgia. Two days after the shoulder pain, the patient presented a dysphagia necessitating tube feeding.  A blood sample confirmed hepatitis caused by hepatitis E virus (HEV; genotype 3F). Oral feeding resumed progressively after five months. The patient was fully independent for the activities of daily living but was still unable to work after six months. Conclusion: Amyotrophic neuralgia and hepatitis E are both under-diagnosed. It is noteworthy that HEV can trigger amyotrophic neuralgia. Antiviral drugs, oral steroids and intravenous immunoglobulins can be proposed, but the optimal treatment has  not yet been determined.