Microbiology Department, University Clinical Lozano Blesa Hospital, Zaragoza, Spain.
Infectious Diseases Unit, Clinical Virology and Zoonoses Unit, Maimonides Institute for Biomedical Research, Reina Sofia Hospital, University of Cordoba, Cordoba, Spain.
Virus Res. 2020 Dec;290:198165. doi: 10.1016/j.virusres.2020.198165. Epub 2020 Sep 29.
Introduction The hepatitis E virus (HEV) is the leading cause of acute hepatitis around the world. In recent years, knowledge has increased concerning extrahepatic manifestations caused by HEV, including neurological manifestations such as Parsonage-Turner syndrome (PTS). PTS is characterized by severe shoulder or arm pain and patchy paresis with muscle weakness. The aim of the present study was to assess the association between HEV and PTS. Materials and Methods We reported two cases of PTS associated with HEV, which were diagnosed in a short period of time in the same village. PTS was diagnosed by physical examination and electrophysiological studies, and serology testing for IgM, low-avidity IgG, and RNA of HEV established the diagnosis of acute HEV infection. Results A 44-year-old man who presented cervicobrachial pain accompanied by paresthesia, dyspnea, and isolated derangement of liver enzymes and 57-year-old women with cervical pain radiated to upper limbs, paresthesia, and liver cytolysis, although, this patient was initially diagnosed as having drug-induced hepatitis. Finally, the diagnosis was Parsonage- Turner syndrome associated with hepatitis e virus. In both patients, symptoms were bilateral and they required hospital admission. Both consumed vegetables are grown in a local patch and the phylogenetic analysis showed genotype 3f. Then, we reviewed the literature on PTS and HEV and we found 62 previously described cases that were more likely to be men (86.20 %) with more frequent bilateral symptoms (85.71 %). Genotype 3 is the most commonly associated. Three of those cases were diagnosed in Spain. Conclusions According to our findings, HEV should be considered in patients with neuralgic amyotrophy, including those with the absence of liver cytolysis.
戊型肝炎病毒（HEV）是全球范围内导致急性肝炎的主要原因。近年来，人们对 HEV 引起的肝外表现有了更多的认识，包括神经表现，如帕森斯-特纳综合征（PTS）。PTS 的特征是严重的肩部或手臂疼痛以及伴有肌肉无力的斑片状弛缓性瘫痪。本研究旨在评估 HEV 与 PTS 之间的相关性。
我们报告了两例在同一村庄短时间内诊断出的与 HEV 相关的 PTS 病例。PTS 通过体格检查和电生理研究诊断，HEV 的 IgM、低亲和力 IgG 和 RNA 血清学检测确立了急性 HEV 感染的诊断。
一名 44 岁的男性出现颈臂疼痛伴感觉异常、呼吸困难和孤立的肝酶紊乱，以及一名 57 岁的女性出现颈痛放射至上肢、感觉异常和肝功能障碍，尽管该患者最初被诊断为药物性肝炎。最终诊断为与戊型肝炎病毒相关的帕森斯-特纳综合征。在这两名患者中，症状均为双侧，需要住院治疗。两人均食用生长在当地一块地的蔬菜，系统进化分析显示基因型为 3f。然后，我们查阅了关于 PTS 和 HEV 的文献，发现了 62 例先前描述的病例，这些病例更可能发生在男性（86.20%）中，且更常表现为双侧症状（85.71%）。基因型 3 是最常相关的类型。其中有 3 例在西班牙诊断。
根据我们的发现，在出现神经痛性肌萎缩的患者中，包括那些没有肝功能障碍的患者，应考虑 HEV 的可能性。
