title: Hepatitis E-induced severe myositis.
abstract: BACKGROUND
  Hepatitis E virus (HEV) is endemic in Asian and African countries but is rarely reported in Western countries. Although there are some prominent neurological manifestations, HEV is rarely recognized by neurologists.
  
  
  METHODS
  This is a case report of myositis induced by HEV.
  
  
  RESULTS
  We report the life-threatening case of a 57-year-old man with flaccid tetraparesis due to myositis, acute hepatitis, and renal failure caused by HEV infection. Muscle biopsy revealed scattered myofiber necrosis with a diffuse, mild lymphomonocytic infiltrate in the endomysium and perimysium. Because the patient suffered from an acute HEV infection with a rapidly progressive course of severe myopathy, we started ribavirin treatment. He recovered partially within 3 weeks and recovered fully within 6 months.
  
  
  CONCLUSIONS
  This case highlights a neurological manifestation of endemic HEV infection with severe myositis in a patient with alcoholic chronic liver disease. Ribavirin treatment is effective in severe HEV infection and may also lead to rapid neurological recovery.
authors.affiliation: Department of Neurology, Charité, Berlin, Charitéplatz 1, Germany.
authors.forename: Annerose M
authors.initials: AM
authors.lastname: Mengel
authors.affiliation: Department of Neuropathology, Charité, Berlin, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Stenzel
authors.affiliation: Department of Neurology, Charité, Berlin, Charitéplatz 1, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meisel
authors.affiliation: Department of Gastroenterology and Hepatology, Kr. Waldfriede, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Büning
mesh_terms: D004576:Electromyography; D016751:Hepatitis E / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009220:Myositis / Q000175:diagnosis / Q000209:etiology* / Q000821:virology*
keywords: hepatitis E; myositis; neurological disorders in hepatitis E; rhabdomyolysis; ribavirin