title: Hepatitis E virus infection as a direct cause of neuralgic amyotrophy.
abstract: We describe a patient who developed neuralgic amyotrophy (NA) related to hepatitis E virus (HEV) infection.
  
  
  
  The patient underwent neurological and electrodiagnostic examinations, high-resolution analysis of serological changes, and HEV load profile, and was treated with intravenous immunoglobulin.
  
  
  
  There was evidence of bilateral, asymmetric acute inflammatory cervical polyradiculopathy and possible brachial plexopathy. Positive serum anti-HEV IgM was followed by seroconversion to anti-HEV IgG positivity. A calculated anti-HEV antibody index was compatible with intrathecal synthesis, and HEV genotype 3 RNA was found in serum and cerebrospinal fluid (CSF). Liver function tests returned to normal within 6 weeks.
  
  
  
  Bilateral involvement of cervical nerve roots and/or plexus, elevated liver function tests, and abnormal CSF are typical features of HEV-associated NA. The pathogenesis involves possible immune-mediated mechanisms. However, our findings support the hypothesis that HEV-related NA is associated with direct infection. Muscle Nerve 54: 325-327, 2016.
authors.affiliation: Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silva
authors.affiliation: Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Benoît
authors.initials: B
authors.lastname: Wicki
authors.affiliation: Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Tsouni
authors.affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cunningham
authors.affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Doerig
authors.affiliation: Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.|Service of Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zanetti
authors.affiliation: Service of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Aubert
authors.affiliation: Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Sahli
authors.affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: Darius
authors.initials: D
authors.lastname: Moradpour
authors.affiliation: Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Kuntzer
mesh_terms: D020968:Brachial Plexus Neuritis / Q000209:etiology* / Q000503:physiopathology / Q000821:virology*; D016751:Hepatitis E / Q000150:complications*; D016752:Hepatitis E virus / Q000472:pathogenicity*; D006801:Humans; D008297:Male
keywords: HEV RNA; acute cervical radiculoplexopathy; anti-HEV antibody; intravenous immunoglobulins; neuralgic amyotrophy