RESUMO
BACKGROUND: The aim of this study was to further characterize the clinical phenotype of hepatitis E virus (HEV)-associated neuralgic amyotrophy (NA). METHODS: Three patients with HEV-associated NA underwent clinical, electrodiagnostic, and ultrasound assessment. RESULTS: In all patients, symptoms developed in several phases within a time span of 4-6 weeks, with three or more nerves involved. Symptoms were bilateral in two. In two patients, nerves of the trunk and the lower limb were affected as well. In one patient, three bouts occurred, each heralded by an increase in pain. In the other two, pain subsided quickly and nerve damage developed in two phases. Segmental enlargement with or without hourglass-like constrictions of the nerves was demonstrated by ultrasound in all. CONCLUSIONS: The multiphasic presentation, together with the extensive multi-nerve involvement, may reflect a severe and protracted inflammation of the nerves in HEV-associated NA.
Assuntos
Neurite do Plexo Braquial/diagnóstico , Neurite do Plexo Braquial/etiologia , Hepatite E/complicações , Adulto , Plexo Braquial/diagnóstico por imagem , Neurite do Plexo Braquial/diagnóstico por imagem , Eletrodiagnóstico , Eletromiografia , Hepatite E/diagnóstico por imagem , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Fenótipo , Nervos Espinhais/diagnóstico por imagem , Nervos Torácicos/diagnóstico por imagem , UltrassonografiaAssuntos
Hepatite E/patologia , Falência Hepática Aguda/etiologia , Fígado/patologia , Injúria Renal Aguda/complicações , Consumo Excessivo de Bebidas Alcoólicas/complicações , Diagnóstico Diferencial , Hepatite E/complicações , Hepatite E/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , UltrassonografiaAssuntos
Síndrome de Guillain-Barré/etiologia , Hepatite E/complicações , Síndrome de Guillain-Barré/diagnóstico por imagem , Hepatite E/diagnóstico por imagem , Humanos , Fígado/virologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Coluna Vertebral/diagnóstico por imagemRESUMO
BACKGROUND AND AIM: The data available on subacute hepatic failure due to hepatitis E virus is scarce. The aim of this study is to analyze the clinical spectrum and outcome of this condition. METHODS: This is a retrospective hospital-based study of patients with acute hepatitis E and subacute hepatic failure from January 2001 to June 2006. RESULTS: We encountered 12 patients with this condition during the study period. There were four females and eight males (age 39 +/- 16). Jaundice and ascites were present in all. The model for end stage liver disease (MELD) score was 25 +/- 8. All of them had normal-sized liver on ultrasonogram. Transjugular liver biopsies were done in nine patients and revealed extensive bridging, submassive necrosis and cholestasis. Complications included spontaneous bacterial peritonitis (four) and urinary tract infections (two), renal failure (three) and encephalopathy (three). The in-hospital mortality was 25% (3/12). The remaining nine patients left the hospital alive with normalization of liver functions in eight of them over the next few months. CONCLUSION: Subacute hepatic failure caused by hepatitis E is a distinct entity with a better prognosis compared with the previously published series of subacute hepatic failure. Liver biopsy is useful to differentiate from hepatitis E virus superinfection on underlying chronic disease. Poor prognostic factors were female sex, younger age, encephalopathy and persistent renal failure. These patients should be considered for liver transplantation.
Assuntos
Hepatite E/complicações , Hepatite E/diagnóstico , Falência Hepática Aguda/diagnóstico , Falência Hepática Aguda/virologia , Adulto , Ascite/etiologia , Biópsia/métodos , Criança , Diagnóstico Diferencial , Feminino , Hepatite E/diagnóstico por imagem , Hepatite E/mortalidade , Hepatite E/patologia , Hospitais Universitários , Humanos , Índia , Icterícia/etiologia , Falência Hepática Aguda/diagnóstico por imagem , Falência Hepática Aguda/mortalidade , Falência Hepática Aguda/patologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , UltrassonografiaRESUMO
Hepatitis E is an emerging viral infection in developed countries. It can present with multiple extra-hepatic manifestations, including neuralgic amyotrophy. We report a 52-year-old man who presented with neck and shoulder pain followed by orthopnea and left arm weakness. Electrodiagnostic testing showed left phrenic neuropathy and denervation in bilateral C5 and C6 myotomes. He also had elevated liver enzymes, which led to the diagnosis of acute hepatitis E. This is the first case of neuralgic amyotrophy associated with hepatitis E in the United States. Hepatitis E should be considered in patients with neuralgic amyotrophy, particularly men with bilateral symptoms, and if there is unexplained elevation of transaminases. The role of antiviral therapy remains unclear.