Hepatitis E Virus‐Induced Neurological Symptoms in a Kidney‐Transplant Patient with Chronic Hepatitis

Abstract

It has been shown that hepatitis E virus (HEV) may be responsible for chronic hepatitis in solid-organ transplant patients. It has also been suggested that HEV may be responsible for atypical neurological symptoms during the acute phase. However, the relationship between the neurological symptoms and HEV infection was based on the detection of anti-HEV IgM in the sera. Herein, we report a case where neurological symptoms, that is peripheral nerve involvement with proximal muscular weakness that affected the four limbs joints with central nervous-system involvement and bilateral pyramidal syndrome, occurred in a kidney-transplant patient who was chronically infected by HEV. For the first time, HEV RNA was detected in the serum and cerebrospinal fluid. In addition, clonal HEV sequences were analyzed in both compartments, that is serum and cerebrospinal fluid. The discovery of quasispecies compartmentalization and its temporal association suggests that neurological symptoms could be linked to the emergence of neurotropic variants.

Hepatitis E: Epidemiology and Natural History

“…87 Another unusual feature of HEV infection in these areas is the occurrence of a wide variety of neurological syndromes in association with genotype 3 HEV infection. 88,89 However, these syndromes are not seen in patients with acute infection due to genotype 1 or 2 HEV infection in high-endemicity areas.…”

Chronic Hepatitis E Virus Infection and Treatment

“…99 Clonal HEV sequences in the serum and CSF of a kidneytransplant patient with chronic hepatitis and neurological symptoms showed quasispecies compartmentalization, which suggests that neurological symptoms could be linked to the emergence of neurotropic variants. 100 In addition, cases of anti-ganglioside GM1-positive and anti-GM2-positive Guillain-Barre syndrome, caused by HEV infection, have been reported. 91,92 Very recently, a case of Guillain-Barre syndrome has been reported associated with severe necrotizing myositis, which occurred in a liver-transplant patient during an acute HEV-3 infection phase, but who recovered after ribavirin therapy.…”

Association of Bell's Palsy with Hepatitis E Virus Infection: A Rare Entity

“…1,14,15 The HEV-RNA sequences in serum and CSF have showed differences, suggesting that neurologic symptoms may have been related to the emergence of neurotropic variants. Genotyping was done in 11 European patients, all were genotype 3.…”

“…immunoglobulins/plasmapheresis. 1,6,8,9,13,14,[16][17][18] In immunocompromised organ-transplant patients, dose modification or cessation of immunosuppressant drugs was done. 1 In a patient of retroviral infection, pegylated interferon/ ribavirin was given for painful sensory peripheral neuropathy.…”

“…1 Neurologic involvement in HEV is distinctly rare and approximately 24 cases have been described so far. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Reports of 22 cases are summarized in Table 1. 1,[6][7][8][9][10][11][13][14][15][16][17][18][19][20] Guillain-Barré syndrome, 1,6 (Table 1).…”