A curable pseudo-dementia related to an atypical presentation of giant cell arteritis.

A 70-year-old patient was admitted with rapidly progressive cognitive decline associated with limitations in activities of daily living, weight loss and cerebellar ataxia. The diagnosis of giant cell arteritis (GCA) with vascular involvement was made, based on the presence of a metabolically active vasculitis of the brachiocephalic trunk on 18FDG-PET imaging. Temporal artery biopsy also revealed pan-arteritis. A progressive regression of cognitive disorders occurred under corticosteroid treatment and immunosuppressive therapy. Previously published case reports concerning this atypical presentation of GCA are scarce. They suggest that numerous cognitive symptoms, such as impairment of short-term memory, disorientation, delirium, impaired attention or visual hallucinations might be related to GCA. Thus, this diagnosis should be considered as a curable cause of unexplained cognitive impairment associated with weight loss and systemic inflammation.

Management of inflammatory rheumatic conditions in the elderly.

The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.

A Novel Smartphone Accelerometer Application for Low-Intensity Activity and Energy Expenditure Estimations in Overweight and Obese Adults.

Physical inactivity and sedentary behaviors are on the rise worldwide and contribute to the current overweight and obesity scourge. The loss of healthy life style benchmarks and the lack of the need to move make it necessary to provide feedback about physical and sedentary activities in order to promote active ways of life. The aim of this study was to develop a specific function adapted to overweight and obese people to identify four physical activity (PA) categories and to estimate the associated total energy expenditure (TEE). This function used accelerometry data collected from a smartphone to evaluate activity intensity and length, and TEE. The performance of the proposed function was estimated according to two references (Armband® and FitmatePro®) under controlled conditions (CC) for a 1.5-h scenario, and to the Armband® device in free-living conditions (FLC) over a 12-h monitoring period. The experiments were carried out with overweight and obese volunteers: 13 in CC and 27 in FLC. The evaluation differences in time spent in each category were lower than 7% in CC and 6% in FLC, in comparison to the Armband® and FitmatePro® references. The TEE mean gap in absolute value between the function and the two references was 9.3% and 11.5% in CC, and 8.5% according to Armband® in FLC.

Effectiveness and safety of abatacept in elderly patients with rheumatoid arthritis enrolled in the French Society of Rheumatology's ORA registry.

OBJECTIVE: To study the effect of age on the risk-benefit balance of abatacept in RA. METHODS: Data from the French orencia and RA registry, including a 2-year follow-up, were used to compare the effectiveness and safety of abatacept according to age. RESULTS: Among the 1017 patients, 103 were very elderly (⩾75 years), 215 elderly (65-74), 406 intermediate aged (50-64) and 293 very young (<50). At baseline, elderly and very elderly patients had longer disease duration, higher CRP levels and higher disease activity. These age groups showed a lower incidence of previous anti-TNF therapy and less common concomitant use of DMARDs, but a similar use of corticosteroid therapy. After adjusting for disease duration, RF/ACPA positivity, use of DMARDs or corticosteroids and previous anti-TNF treatment, the EULAR response (good or moderate) and the remission rate were not significantly different between the four age groups. At 6 months, the very elderly had a significantly lower likelihood of a good response than the very young (odds ratio = 0.15, 95% CI: 0.03, 0.68). The decrease in DAS28-ESR over the 24-month follow-up period did not differ by age. Increasing age was associated with a higher rate of discontinuation for adverse events, especially severe infections (per 100 patient-years: 1.73 in very young, 4.65 in intermediates, 5.90 in elderly, 10.38 in very elderly; P < 0.001). CONCLUSION: The effectiveness of abatacept is not affected by age, but the increased rate of side effects, especially infections, in the elderly must be taken into account.

Enhanced pain sensitivity in obese patients with obstructive sleep apnoea syndrome is partially reverted by treatment: An exploratory study.

BACKGROUND: Obesity is frequently associated with obstructive sleep apnoea syndrome (OSA) and chronic pain. OSA as well as continuous positive airway pressure (CPAP) treatment may modulate the pain perception threshold (PT) in patients with obesity. METHODS: In this prospective, longitudinal study, all patients admitted for obesity assessment were screened for OSA by nocturnal polygraphy (SOMNOcheck® , IAH ≥10) and performed mechanical (Von Frey electronic device) and electrical (PainMatcher® ) pain tests. Those with severe OSA were retested for PT 1 month after initiation of CPAP therapy. Newly diagnosed patients with severe OSA (hypopnea apnoea index >30) have been offered to start CPAP treatment. RESULTS: Among 85 patients, there were 27 OSA patients, aged between 40 ± 13.2 years with a BMI of 42 ± 7.2 kg/m2 . Severe OSA patients (N = 11) showed a lower PT than non-OSA patients (N = 58) during mechanical (177 ± 120 vs. 328 ± 136 g, p < 0.01) and electrical methods (7.4 ± 6.4 vs. 12.9 ± 6.7 stimulation duration steps; p = 0.03). In the severe OSA group (N = 7), an increased PT was observed 1 month after CPAP treatment during mechanical pain testing (298 ± 69 vs. 259 ± 68 g, p < 0.05), but not during electrical pain testing (11.5 ± 3.0 vs. 12.4 ± 3.8 stimulation duration steps, p = 0.50). CONCLUSION: In patients with obesity, this exploratory study showed that the presence of an OSA is associated with a decreased PT, whereas implantation of a CPAP device tends to normalize pain perception.

High-density Surface Electromyography as Biomarker of Muscle Aging.

Sarcopenia is a muscle disease with adverse changes that increase throughout the lifetime but with different chronological scales between individuals. Addressing "early muscle aging" is becoming a critical issue for prevention. Through the CHRONOS study, we demonstrated the ability of the high-density surface electromyography (HD-sEMG), a noninvasive, wireless, portable technology, to detect both healthy muscle aging and accelerated muscle aging related to a sedentary lifestyle, one of the risk factors of sarcopenia. The HD-sEMG signals were analyzed in 91 healthy young, middle-aged, and old subjects (25-75 years) distributed according to their physical activity status (82 active and 9 sedentary; International Physical Activity Questionnaire) and compared with current methods for muscle evaluation, including muscle mass (dual-energy X-ray absorptiometry [DXA], ultrasonography), handgrip strength, and physical performance. The HD-sEMG signals were recorded from the rectus femoris during sit-to-stand trials, and 2 indexes were analyzed: muscular contraction intensity and muscle contraction dynamics. The clinical parameters did not differ significantly across the aging and physical activity levels. Inversely, the HD-sEMG indexes were correlated to age and were different significantly through the age categories of the 82 active subjects. They were significantly different between sedentary subjects aged 45-54 years and active ones at the same age. The HD-sEMG indexes of sedentary subjects were not significantly different from those of older active subjects (≥55 years). The muscle thicknesses evaluated using ultrasonography were significantly different between the 5 age decades but did not show a significant difference with physical activity. The HD-sEMG technique can assess muscle aging and physical inactivity-related "early aging," outperforming clinical and DXA parameters.

Transfemoral versus trans-subclavian access in transcatheter aortic valve implantation using self-expandable valve: A propensity-matched comparison.

BACKGROUND: Transcatheter aortic valve implantation is unfeasible for 10-15% of patients using the conventional transfemoral approach. Other alternative approaches, such as the subclavian approach, have emerged, with no clear recommendation indicating the superiority of one technique over another. AIM: To compare the 1-month mortality and postprocedural outcomes of patients undergoing transcatheter aortic valve implantation using a self-expandable valve via transfemoral and subclavian access. METHODS: This was a retrospective single-centre study including 1496 patients who underwent transcatheter aortic valve implantation between January 2016 and December 2020 at Clermont-Ferrand University Hospital, France. Propensity score matching was used to compare transfemoral and subclavian access. RESULTS: After building two propensity score-matched groups of 221 patients each with either access route (total n=442), baseline characteristics were similar. The procedure duration was significantly longer in the subclavian access group (53 [45-64] versus 60 [51-72] minutes; P<0.001), but with a lower amount of contrast agent (138 [118-165] versus 123 [105-150] mL; P<0.001), fluoroscopy time (11.2 [9-14] versus 9.9 [7-12] minutes; P<0.001) and radiation dose (397 [264-620] versus 321 [217-485] mGy; P<0.001). No significant difference was observed concerning 1-month mortality (odds ratio 1.62, 95% confidence interval 0.52-5.03; P=0.39) or periprocedural complications. Follow-up at 1 year confirmed no difference in longer-term mortality (hazard ratio 0.78, 95% confidence interval 0.52-5.03; P=0.43). CONCLUSIONS: The subclavian approach provides similar results to the transfemoral approach in terms of mortality, efficacy and safety; it is a reasonable and effective alternative when the reference transfemoral approach is impossible or seems complex.

Minerals and Antioxidant Micronutrients Levels and Clinical Outcome in Older Patients Hospitalized for COVID-19 during the First Wave of the Pandemic.

Excessive inflammatory response has been implicated in severe respiratory forms of coronavirus disease 2019 (COVID-19). Trace elements such as zinc, selenium, and copper are known to modulate inflammation and immunity. This study aimed to assess the relationships between antioxidant vitamins and mineral trace elements levels as well as COVID-19 severity in older adults hospitalized. In this observational retrospective cohort study, the levels of zinc, selenium, copper, vitamin A, ß-carotene, and vitamin E were measured in 94 patients within the first 15 days of hospitalization. The outcomes were in-hospital mortality secondary to COVID-19 or severe COVID-19. A logistic regression analysis was conducted to test whether the levels of vitamins and minerals were independently associated with severity. In this cohort (average age of 78 years), severe forms (46%) were associated with lower zinc (p = 0.012) and ß-carotene (p < 0.001) concentrations, and in-hospital mortality (15%) was associated with lower zinc (p = 0.009), selenium (p = 0.014), vitamin A (p = 0.001), and ß-carotene (p = 0.002) concentrations. In regression analysis, severe forms remained independently associated with lower zinc (aOR 2.13, p = 0.018) concentrations, and death was associated with lower vitamin A (aOR = 0.165, p = 0.021) concentrations. Low plasma concentrations of zinc and vitamin A were associated with poor prognosis in older people hospitalized with COVID-19.

[Knowledge and application of the HAS recommendations concerning the diagnosis of undernutrition in people aged 70 and above: an international online survey among members of the "Société Française de Gériatrie et de Gérontologie"]. / Connaissances et application des recommandations HAS concernant le diagnostic de la dénutrition chez la personne de 70 ans et plus : une enquête menée en ligne auprès des membres de la Société française de gériatrie et de gérontologie.

OBJECTIVES: To assess the knowledge and the use in clinical practice of the "French National Authority for Health" (HAS) 2021 recommendations on the diagnosis of malnutrition in older adults aged 70 years and above. METHODS: An online survey was developed by the working Group on Geriatrics and Nutrition (GEGN) of the "Société Française de Gériatrie et de Gérontologie (SFGG)" and conducted among members of the SFGG. A self-administered questionnaire composed of 21 closed questions was used. RESULTS: A total of 132 (10.2 %) members of the SFGG responded to the survey. The respondents were aged 43.4 ± 9.94 years old and 97 (73.5 %) were women. Almost half of them were medical doctors (n = 53 ; 40.2 %). Of the respondents, 81 % had already heard of the HAS 2021 recommendations. This percentage is higher for doctors (96 %) than for other professions (74 %). French respondents were more likely to have heard of these -recommendations (84 %) than respondents from other countries (42.9 %). However, only 41.6 % of the respondents believe they know these recommendations in detail. On a visual analogue scale from 0 (never) to 100 (always), respondents use these recommendations in their professional practice at 76.8 ± 20.2 %. However, on a scale from 0 (never difficult) to 100 (always difficult), some barriers to their use in clinical practice were highlighted. These mainly concerned the measurement of muscle mass (84.4 ± 17.2 %) and muscle strength (79.5 ± 19.9 %) in patients. CONCLUSION: Although the majority of respondents use the HAS 2021 recommendations in their professional practice, they often have difficulties in measuring muscle strength and muscle mass of their patients. The assessment of sarcopenia still needs to be implemented in clinical routine. Until then, better communication about simple alternatives that do not require special equipment is needed.

Comparison of length of stay between direct entry and emergency admission in acute care geriatric unit after hotline regulation / Comparaison de la durée moyenne de séjour des patients hospitalisés dans le service de court séjour gériatrique en entrée directe ou via les urgences après régulation par la ligne téléphonique dédiée

Introduction: Development of the geriatric care allows direct hospitalization and avoid unnecessary emergency admissions. In Clermont-Ferrand, a specific hotline regulates direct entry from home and emergencies in the geriatric acute care unit. The aim of this study was to evaluate the impact of the entry mode (home or emergency) on the length of stay of patients hospitalized in acute care geriatric unit. Materials and methods: We have retrospectively collected data on hospitalization of patients over 75 years in the Geriatric Acute care unit from January to March 2019. We also collected socio-demographic data, autonomy score, MMS, co-morbidity score, exit mode, previous year's hospitalization and polymedication on hospitalization reports. Results: We included 88 patients in the "direct" group and 184 patients in the "emergency" group. The characteristics of the two groups were comparable. The median length of stay for the "emergency" group was 14 days [9.5; 20] versus 12 [8.5; 18] for the "direct" group (p=0.03). In multivariate analysis, ADL score and home lifestyle were correlated with duration of stay. Conclusion: The development of direct entrance pathways into the geriatric short-stay department by establishing specific hotlines decreases length of stay.

Le développement des filières gériatriques permet une hospitalisation en entrée directe évitant le passage par les urgences. À Clermont-Ferrand, depuis 2011, une ligne téléphonique dédiée permet une régulation des entrées. L'objectif de cette étude est d'évaluer l'impact du mode d'entrée (directe ou urgences) sur la durée moyenne de séjour (DMS) chez les patients hospitalisés en court séjour gériatrique (CSG). Méthodes: La DMS, ainsi que les données socio démographiques, le score d'autonomie, le MMS, les comorbidités, le mode de sortie, la survenue d'une hospitalisation dans l'année précédente et la polymédication ont été recueillis de manière rétrospective chez les patients âgés de plus de 75 ans. Résultats: 272 patients ont été inclus (88 « entrées directes ¼ et 184 « urgences ¼). Les caractéristiques des groupes étaient comparables. La durée médiane de séjour pour le groupe « urgences ¼ était de 14 [9,5 ; 20] contre 12 [8,5 ; 18] pour l'autre groupe (p = 0,03). En analyse multivariée, le score d'ADL et le mode de vie étaient corrélés à la DMS avec respectivement p = 0,009 et p = 0,018. Conclusion: La création de filières d'entrées directes en CSG par la mise en place de lignes téléphoniques dédiées permet une réduction de la DMS.

Body Mass Trajectory Affects the Long-Term Occurrence of Metabolic Syndrome in Adult Patients with Severe Obesity.

Independently of absolute BMI values, the amount, onset date, and duration of early body weight gain may influence cardio-metabolic health later in adulthood. Values of cardiac and metabolic variables from a cohort study of morbidly obese patients were retrospectively analyzed to study the association between early weight history and metabolic syndrome (MetS) occurrence in adults. Of 950 patients with severe morbid obesity (age 44.3 ± 13.8 y, BMI 42.5 ± 7.0 kg/m2), 31.4% had started excess weight gain in childhood (CH), 19.9% in adolescence (ADO), and 48.7% in adulthood (AD). Despite different BMI values, MetS prevalence (57.8%) was not significantly different in the three groups (54.4% CH vs. 57.7% ADO vs. 59.8% AD, p = 0.59). The overweight onset period was not significantly associated with the development of MetS in adults (ADO: OR = 1.14 [0.69-1.92], p = 0.60; AD: OR = 0.99 [0.62-1.56], p = 0.95) despite a higher BMI in the early obesity onset group. Weight gain of more than 50% after age 18 years significantly increased the risk of MetS (OR = 1.75 [1.07-2.88], p = 0.026). In addition to crude BMI values, analysis of body mass trajectories is a relevant clinical tool in the assessment of metabolic risk, suggesting that the magnitude of weight gain may be more important for metabolic syndrome progression than the period of obesity onset.

Does iron overload in metabolic syndrome affect macrophage profile? A case control study.

AIMS: Dysmetabolic iron overload syndrome (DIOS) is common but the clinical relevance of iron overload is not understood. Macrophages are central cells in iron homeostasis and inflammation. We hypothesized that iron overload in DIOS could affect the phenotype of monocytes and impair macrophage gene expression. METHODS: This study compared 20 subjects with DIOS to 20 subjects with metabolic syndrome (MetS) without iron overload, and 20 healthy controls. Monocytes were phenotyped by Fluorescence-Activated Cell Sorting (FACS) and differentiated into anti-inflammatory M2 macrophages in the presence of IL-4. The expression of 38 genes related to inflammation, iron metabolism and M2 phenotype was assessed by real-time PCR. RESULTS: FACS showed no difference between monocytes across the three groups. The macrophagic response to IL-4-driven differentiation was altered in four of the five genes of M2 phenotype (MRC1, F13A1, ABCA1, TGM2 but not FABP4), in DIOS vs Mets and controls demonstrating an impaired M2 polarization. The expression profile of inflammatory genes was not different in DIOS vs MetS. Several genes of iron metabolism presented a higher expression in DIOS vs MetS: SCL11A2 (a free iron transporter, +76 %, p = 0.04), SOD1 (an antioxidant enzyme, +27 %, p = 0.02), and TFRC (the receptor 1 of transferrin, +59 %, p = 0.003). CONCLUSIONS: In DIOS, macrophage polarization toward the M2 alternative phenotype is impaired but not associated with a pro-inflammatory profile. The up regulation of transferrin receptor 1 (TFRC) in DIOS macrophages suggests an adaptive role that may limit iron toxicity in DIOS.

Abatacept for Treatment of Rheumatoid Arthritis: Special Focus on the Elderly.

Targeted therapies have been developed for patients with rheumatoid arthritis (RA) for whom prior treatment with traditional disease-modifying anti-rheumatic drugs has failed. The numerous different signaling pathways now targeted by various classes of monoclonal antibodies and small molecule inhibitors may complicate treatment decisions. Abatacept selectively modulates a co-stimulatory signal necessary for T-cell activation. Thus, abatacept is effective in biologic-naive patients and in those for whom biologic therapy has failed. Emerging evidence indicates different benefits depending on patient and disease characteristics. In RA, the clinical goal should be clinical and radiographic remission to prevent structural damage and functional impairment. Nevertheless, the management of elderly patients with RA is often less aggressive, and the treat-to-target strategy is less respected in this age category than in the treatment of RA in younger patients. However, abatacept treatment in elderly patients is as effective and well-tolerated as in younger patients. This review summarizes recently published data on pharmacological properties; clinical and biological data on efficacy, drug retention, and safety, focusing on age; and evidence-based criteria for choosing abatacept or an alternative targeted therapy.

A Moderate Supplementation of Native Whey Protein Promotes Better Muscle Training and Recovery Adaptations Than Standard Whey Protein - A 12-Week Electrical Stimulation and Plyometrics Training Study.

The purpose of this study was to assess if native whey protein (NW) supplementation could promote recovery and training adaptations after an electrostimulation (ES) training program combined to plyometrics training. Participants were allocated into three groups, supplemented 5 days/week, either with 15 g of carbohydrates + 15 g of NW (n = 17), 15 g of carbohydrates + 15 g of standard whey protein (SW; n = 15), or placebo (PLA; 30 g of carbohydrates; n = 10), while undergoing a 12-week ES training program of the knee extensors. Concentric power (Pmax) was evaluated before, immediately after, as well as 30 min, 60 min, 24 h, and 48 h after the 1st, 4th and last ES training session. The maximal voluntary contraction torque (MVC), twitch amplitude, anatomical cross-sectional area (CSA) and maximal voluntary activation level (VA) were measured before (T0), and after 6 (T1) and 12 weeks of training (T2). P max recovery kinetics differed between groups (p < 0.01). P max started to recover at 30 min in NW, 24 h in SW and 48 h in PLA. Training adaptations also differed between groups: MVC increased between T0 and T2 in NW (+11.8%, p < 0.001) and SW (+7.1%, p < 0.05), but not PLA. Nevertheless, the adaptation kinetics differed: MVC increased in NW and SW between T0 and T1, but an additional gain was only observed between T1 and T2 in NW. VA declined at T1 and T2 in PLA (-3.9%, p < 0.05), at T2 in SW (-3.5%, p < 0.05), and was unchanged in NW. CSA increased, but did not differ between groups. These results suggest that NW could promote a faster recovery and neuromuscular adaptations after training than SW. However, the mechanisms underlying this effect remain to be identified.

Overview of biologic treatments in the elderly.

As life expectancies rise, the number of elderly people with inflammatory rheumatic diseases will continue to grow. Treatment of this frail population, whose clinical features differ from those of younger subjects, poses new challenges to healthcare systems. However, this issue is rarely addressed in the current literature. Thanks to their targeted mechanism of action, biologics represent one of the major therapeutic advances of the last 15 years, but their use in the elderly has been slow in developing. Published data, derived mainly from cohorts, focus on the use of TNF inhibitors in rheumatoid arthritis and show that these treatments are effective and generally well tolerated. Nevertheless, the risk of infection and cancer, particularly skin and lymphoid malignancies, must not be neglected. The use of these biologics as second-line treatment improves patient outcomes and comfort, while reducing consumption of the widely used and more deleterious drugs such as glucocorticoids and non-steroidal anti-inflammatory drugs. Additional studies on biologics, focusing on the longer term and in indications apart from anti-TNF therapies in rheumatoid arthritis should help overcome some of the reluctance and promote the rational use of these drugs in the elderly.

Immune-mediated myopathy related to anti 3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies as an emerging cause of necrotizing myopathy induced by statins.

Immune-mediated necrotizing myopathy (IMNM) associated with statin use and anti 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody is a new and emerging entity that supports a link between statin use and IMNM and raises the questions of distinct clinical phenotypes and treatment strategy. We describe the clinical and histopathological characteristics of a patient and discuss the spectrum of IMNM and statin-induced myopathies. A 65-year-old man was suffering from proximal muscle weakness and elevated CK levels, following exposure to statin therapy. The symptoms worsened despite discontinuation of the drug. At that point, no myositis-specific or -associated antibodies were detected. Malignancy screening did not reveal abnormalities. Muscle biopsy demonstrated a predominantly necrotizing myopathy with minimal lymphocytic infiltrates, MHC class I expression in necrotic muscle fibers, and complement deposition on scattered non-necrotic muscle fibers. Muscle protein analysis by western blot was normal. The patient did not improve with steroid and methotrexate and required monthly intravenous immunoglobulin (IVIG) therapy. Muscle strength gradually improved, CK levels normalized and IVIG were stopped 1 year later. Screening for anti-HMGCR antibodies, not available at the time of presentation, was highly positive. Identification of anti-HMGCR antibodies in statin-exposed patients with myopathy appears to be helpful both for differential diagnosis and for treatment strategy. In patients who did not improve after discontinuation of the statin treatment, a muscle biopsy should be performed as well as screening for anti-HMGCR antibodies. Patients with this disorder require aggressive immunosuppressive treatment.

Vascular effects of nonsteroidal antiinflammatory drugs.

The effect of nonsteroidal antiinflammatory drugs (NSAIDs) on the risk of cardiovascular events remains controversial. Among NSAIDs, only low-dose aspirin exerts protective vascular effects. Low-dose aspirin has been proven effective for secondary prevention. For primary prevention, the usefulness of low-dose aspirin is debated, as illustrated by the differences in recommendations across countries. NSAIDs other than aspirin, whether COX-2 selective or nonselective, increase the risk of cardiovascular events. Among them, naproxen is associated with the smallest risk increase. In patients with a history of coronary artery disease, diclofenac seems to carry the greatest risk, but all NSAIDs should be avoided. Uncertainties persist about aspirin interactions with other NSAIDs and with proton pump inhibitors. An adverse effect of acetaminophen on the risk of cardiovascular disease cannot be completely ruled out.

Severe bilateral amyotrophic neuralgia associated with major dysphagia secondary to acute hepatitis E.

INTRODUCTION: Several acute neurological syndromes can be triggered by immune events. Hepatitis E virus (HEV), an emerging infectious disease, can be one of these triggers. CASE REPORT: We report the case of a 36-year-old man that presented nausea and a dull abdominal pain for a week and then felt an acute neuralgic pain involving both shoulders that lasted for 8 to 10 hours. Immediately after, the patient presented a severe bilateral muscular weakness of the proximal part of both upper limbs, corresponding to an amyotrophic neuralgia. Two days after the shoulder pain, the patient presented a dysphagia necessitating tube feeding.  A blood sample confirmed hepatitis caused by hepatitis E virus (HEV; genotype 3F). Oral feeding resumed progressively after five months. The patient was fully independent for the activities of daily living but was still unable to work after six months. CONCLUSION: Amyotrophic neuralgia and hepatitis E are both under-diagnosed. It is noteworthy that HEV can trigger amyotrophic neuralgia. Antiviral drugs, oral steroids and intravenous immunoglobulins can be proposed, but the optimal treatment has  not yet been determined.