title: Severe bilateral amyotrophic neuralgia associated with major dysphagia secondary to acute hepatitis E.
abstract: BACKGROUND
  Several acute neurological syndromes can be triggered by immune events. Hepatitis E virus (HEV), an emerging infectious disease, can be one of these triggers.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France ; Neuro-Dol, Inserm U1107, Douleur Trigéminale et Migraine, Faculté de Chirurgie Dentaire, F-63000, F-63000, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Moisset
authors.affiliation: CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France ; Clermont Université, Université d'Auvergne, Clermont-Ferrand, F-63000, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vitello
authors.affiliation: CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Bicilli
authors.affiliation: CHU Clermont-Ferrand, Service d'Ophtalmologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Courtin
authors.affiliation: CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Ferrier
authors.affiliation: CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Taithe
authors.affiliation: CHU Clermont-Ferrand, Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Lahaye
authors.affiliation: CHU Clermont-Ferrand, Service de Réanimation Médicale, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Ali Ait
authors.initials: AA
authors.lastname: Hssain
authors.affiliation: Clermont Université, Université d'Auvergne, Clermont-Ferrand, F-63000, France ; CHU Clermont-Ferrand, Service de Néphrologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Garrouste
authors.affiliation: CHU Clermont-Ferrand, Service de Neurologie, CHU Gabriel Montpied, Clermont-Ferrand, F-63000, France ; Neuro-Dol, Inserm U1107, Douleur Trigéminale et Migraine, Faculté de Chirurgie Dentaire, F-63000, F-63000, France ; Clermont Université, Université d'Auvergne, Clermont-Ferrand, F-63000, France.
authors.forename: Clavelou
authors.initials: C
authors.lastname: Pierre