Guillain-Barré syndrome triggered by acute hepatitis E virus infection: The first reported case from Egypt

A man in his early 50 s presented with a 7-day history of progressive, symmetrical weakness that began in the lower limbs and ascended to involve the upper limbs. His symptoms were accompanied by distal paresthesia and complete areflexia. Three weeks prior to presentation, he experienced a self-limiting febrile illness associated with dark urine and elevated transaminase levels, which resolved spontaneously. On admission, laboratory investigations demonstrated elevated liver enzyme levels and positive anti-hepatitis E virus Immunoglobulin M antibodies, confirming acute hepatitis E virus infection. Nerve conduction studies were consistent with the acute inflammatory demyelinating polyneuropathy variant of Guillain-Barré syndrome. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day for 5 days) and was closely monitored for respiratory and autonomic complications. Gradual neurological improvement was observed, along with normalization of liver function tests. To the best our knowledge, this case represents the first documented occurrence of hepatitis E virus-associated Guillain-Barré syndrome in Egypt after a careful review of the literature. It underscores the importance of considering hepatitis E virus infection in the differential diagnosis of Guillain-Barré syndrome, particularly in patients presenting with elevated liver enzymes or a recent history of hepatitis in hepatitis E virus-endemic regions. Early recognition and prompt initiation of immunotherapy may improve neurological recovery and clinical outcomes in this rare but clinically significant association.