van Eijk JJJ, et al. – This study was performed to investigate the clinical phenotype and outcome in hepatitis E virus–associated neuralgic amyotrophy (HEV–NA). Findings revealed that patients with HEV–NA were usually anicteric and had a distinct clinical phenotype, with predominately bilateral asymmetrical involvement of, and more extensive damage to, the brachial plexus. Authors observed more frequent occurrence of involvement outside the brachial plexus in HEV–NA. The relationship between HEV and NA seemed causal, but was easily overlooked. They recommended testing patients presenting with NA for HEV, irrespective of liver function test results. Prospective treatment/outcome studies of HEV–NA were recommended.

Methods

• Authors looked for cases of NA in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome.
• Comparison of cases of HEV–NA with NA cases without evidence of HEV infection was performed.

Results

• Authors studied 57 cases of HEV–NA and 61 NA cases without HEV.
• Findings revealed that 56/57 HEV–NA cases were anti–HEV IgM positive; 53/57 were IgG positive.
• In 38 cases, they recovered HEV RNA from the serum and in 1 from the CSF (all genotype 3).
• In this study, 51/57 HEV–NA cases were anicteric; median alanine aminotransferase 259 IU/L (range 12–2,961 IU/L); in 6 cases, liver function tests were normal.
• HEV–NA cases had more frequent bilateral involvement (80.0% vs 8.6%, p < 0.001), damage outside the brachial plexus (58.5% vs 10.5%, p < 0.01), including phrenic nerve and lumbosacral plexus injury (25.0% vs 3.5%, p = 0.01, and 26.4% vs 7.0%, p = 0.001), reduced reflexes (p = 0.03), sensory symptoms (p = 0.04) with more extensive damage to the brachial plexus.
• The 2 groups were similar regarding outcome at 12 months.