Hafkesbrink Moritz, Schemmerer M, Wenzel J J, Isenmann S
Department of Neurology and Clinical Neurophysiology, GFO Kliniken Niederrhein, St. Josef Hospital, Moers, Germany.
National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany.
Infection. 2025 Feb;53(1):475-479. doi: 10.1007/s15010-024-02361-3. Epub 2024 Aug 14.
Acute hepatitis E infection (HEV), with its high incidence in Europe, should be considered as a differential diagnosis of acute viral hepatitis and can in some cases manifest with pronounced neurological symptoms.
We report on a 33-year-old female patient with severe arthralgia, myalgia, headache and psychomotor deterioration. Laboratory analyses showed elevated transaminases without signs of cholestasis. Acute hepatitis E virus infection was detected in serum. She reported fatigue and dysesthesias not responsive to analgesics. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. HEV RNA was detected in the CSF. The infection remained mild, but dysesthesias persisted. Eight weeks after the first admission, the symptoms worsened again. Complete and sustained remission was achieved following intravenous corticosteroid treatment.
In patients with acute neurological symptoms and liver enzyme elevation, HEV infection should be considered. Neurologic symptoms such as fatigue, arthralgia, myalgia and dysesthesia along with psychomotor retardation should prompt CSF analysis.
戊型肝炎病毒急性感染（HEV）在欧洲发病率较高，应被视为急性病毒性肝炎的鉴别诊断之一，在某些情况下可表现为明显的神经症状。
我们报告一名33岁女性患者，出现严重关节痛、肌痛、头痛和精神运动功能减退。实验室分析显示转氨酶升高，但无胆汁淤积迹象。血清中检测到戊型肝炎病毒急性感染。她自述疲劳和感觉异常，服用镇痛药无效。脑脊液（CSF）分析显示存在炎症综合征。在脑脊液中检测到HEV RNA。感染症状较轻，但感觉异常持续存在。首次入院八周后，症状再次加重。静脉注射皮质类固醇治疗后实现了完全且持续的缓解。
对于出现急性神经症状和肝酶升高的患者，应考虑戊型肝炎病毒感染。疲劳、关节痛、肌痛和感觉异常等神经症状以及精神运动迟缓应促使进行脑脊液分析。
