Maider Iza, Daniel Ramos, Arnau Llauradó, Juan Luis Restrepo-Vera, Mercedes Pallero, Galo Granados, Jose Alemany, Javier Sotoca, Júlia Sampol, Sergi Martí, Daniel Sanchez-Tejerina, Maria Salvadó, Raul Juntas
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引用次数: 0
Abstract
Aim
This study aimed to describe neurological manifestations secondary to hepatitis E virus (HEV) through the description of two clinical cases.
Methods
Two different cases of neuralgic amyotrophy and meningoradiculitis are evaluated in the emergency department of a tertiary referral hospital in 2024.
Results
Case 1: A 43-year-old male presented to the emergency department with proximal weakness and pain in the right upper extremity associated with acute onset of orthopnea. Laboratory tests revealed elevated AST/ALT levels (184/1164 IU/L) and positive HEV IgM and IgG, with detectable serum HEV viral load. Cerebrospinal fluid (CSF) was negative for HEV RNA. A significant decrease in forced vital capacity was observed on transition from the upright to the supine position. Electromyography showed severe bilateral phrenic nerve involvement. The diagnosis of neuralgic amyotrophy with diaphragmatic paralysis secondary to HEV was made. The patient was treated with intravenous immunoglobulins and noninvasive ventilation with partial improvement. Case 2: A 37-year-old male presented to the emergency department with paresthesias and weakness, initially affecting the distal upper and lower extremities and progressing proximally. Laboratory tests showed elevated AST/ALT levels (238/626 IU/L), positive HEV IgM and IgG, and a detectable HEV viral load in serum. HEV RNA was also detected in the CSF. Neurophysiological findings were normal. The patient was diagnosed with acute meningoradiculitis secondary to HEV. Treatment with intravenous immunoglobulins led to complete resolution of symptoms.
Conclusions
In cases of acute neurological symptoms and liver dysfunction, HEV should be considered as a potential causative agent.
目的通过对两例戊型肝炎病毒(HEV)继发性神经学表现的描述。方法对2024年某三级转诊医院急诊科收治的2例神经性肌萎缩症和脑膜根炎进行回顾性分析。结果病例1:一名43岁男性,因右上肢近端无力和疼痛而出现急性发作的骨科。实验室检测显示AST/ALT水平升高(184/1164 IU/L), HEV IgM和IgG阳性,血清HEV病毒载量可检测到。脑脊液(CSF) HEV RNA呈阴性。在从直立到仰卧位的过渡中观察到用力肺活量的显著下降。肌电图显示严重的双侧膈神经受累。诊断为继发于HEV的神经痛性肌萎缩伴膈肌麻痹。患者接受静脉注射免疫球蛋白和无创通气治疗,部分改善。病例2:一名37岁男性因感觉异常和无力就诊于急诊科,最初影响上肢和下肢远端,并向近端进展。实验室检测显示AST/ALT水平升高(238/626 IU/L), HEV IgM和IgG阳性,血清中可检测到HEV病毒载量。在脑脊液中也检测到HEV RNA。神经生理检查正常。该患者被诊断为HEV继发急性脑膜根炎。静脉注射免疫球蛋白治疗导致症状完全缓解。结论在急性神经系统症状和肝功能障碍病例中,应将HEV视为潜在病原体。
期刊介绍:
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