Neurological Manifestations of HEV Infection: A Rare Phenomenon or an Underrecognized Reality?

PMCID: PMC12177195

PMID: 40534221

DOI: 10.1002/brb3.70585

Journal: Brain and behavior

Publication Date: 2025-6-18

Authors: Iza M, Ramos D, Llauradó A, Restrepo‐Vera JL, Pallero M, et al.

Key Points

• HEV can cause diverse neurological manifestations, including neuralgic amyotrophy and meningoradiculitis, in immunocompetent patients
• Initial HEV viral loads were high (83,000 IU/mL and 22,000 IU/mL), with significant liver enzyme elevations
• Clinicians should maintain a high index of suspicion for HEV in cases of acute neurological symptoms with liver involvement, especially with a history of consuming undercooked meat

Summary

This case series explores the neurological manifestations of hepatitis E virus (HEV), highlighting its potential to cause complex neurological complications in immunocompetent patients. The study presents two distinct cases of HEV-associated neurological disorders: one characterized by neuralgic amyotrophy with diaphragmatic paralysis and the other by acute meningoradiculitis, both occurring in male patients with a history of consuming undercooked meat.

Both patients demonstrated significant liver dysfunction, with markedly elevated liver enzymes and positive HEV serological markers. The first patient experienced severe respiratory compromise with bilateral phrenic nerve involvement, requiring noninvasive ventilation and intravenous immunoglobulin treatment. The second patient presented with progressive neurological symptoms that were successfully managed with intravenous immunoglobulins, resulting in complete symptom resolution. These cases underscore the importance of considering HEV as a potential etiology in patients presenting with acute neurological symptoms and concurrent liver dysfunction.