1700 Clinical phenotype and outcome of hepatitis E virus associated neuralgic amyotrophy (hev-na); an international multicentre retrospective comparative study

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 88; no. Suppl 1; pp. A6 - A7
• Main Authors: Van Eijk, JJ, Dalton, Harry R, Ripellino, P, Madden, Richie G, Jones, C, Fritz, M, Gobbi, C, Melli, G, Pasi, E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01-12-2017
• Subjects: Comparative studies; Genotype & phenotype
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp-2017-ABN.18

BackgroundHEV-NA may have a distinct clinical phenotype and outcome compared to cases of NA without HEV infection.MethodsCases of NA were identified in 11 centres from 7 countries, with retrospective analysis of demographics, clinical/laboratory findings, treatment and outcome. HEV-NA cases were compared to NA cases without evidence of HEV infection.Findings57 HEV-NA and 61 NA without HEV cases were studied. 56/57 of HEV-NA cases were IgM positive (53 IgG positive). In 36 HEV RNA was recovered from the serum and in one from the CSF (all genotype 3). 51/57 HEV-NA cases were anicteric (median ALT was 259 IU/L: range 12–2961). In 6 the liver function tests (LFT) were normal. HEV-NA cases were more likely to have bilateral involvement (p<0.001), damage outside the brachial plexus (p<0.01), reduced reflexes (p=0.03), sensory symptoms (p=0.04) with more extensive damage to the brachial plexus. There was no difference in outcome between both groups at 12 months.InterpretationPatients with HEV-NA are usually anicteric with modest rises in ALT and have a distinct clinical phenotype. Involvement outside the brachial plexus is more common. Patients presenting with NA should be tested for HEV, irrespective of LFT. Prospective treatment/outcome studies of HEV-NA are now warranted.