Neuralgic amyotrophy associated with hepatitis E virus

Neuralgic amyotrophy (NA) is characterised by neuropathic pain and patchy paresis of the upper or lower limbs, usually involving the upper and middle trunks of the brachial plexus. The aetiology of NA is varied, with precipitating factors that include trauma, surgery, pregnancy, inoculations and infections. Deranged liver enzymes have been noted in previous NA reports but no cause identified. We describe a case of bilateral NA in a 53-year-old man who presented with peripheral neuropathy and isolated derangement of liver enzymes. Serology was positive for hepatitis E infection and negative for other infections previously described to be associated with NA. The diagnosis was supported by electrophysiological findings. This case report suggests that hepatitis E is a potential cause of NA that had not previously been described in the literature, and further supports a proposed immune pathogenesis underlying the condition.