Acute hepatitis E-related Guillain-Barré syndrome

To the editor, Hepatitis E Virus (HEV) is the most common cause of acute viral hepatitis globally. Recent European serosurveys show age-dependent increases, corresponding to ongoing zoonotic exposure. Despite this, HEV remains largely underdiagnosed (1,2). Although usually self-limiting, complications are prolonged cholestasis and rarely acute hepatic failure . A distinctive feature of HEV is its extra-hepatic involvement with predominant neurologic manifestations, such as Guillain-Barré Syndrome (GBS) and neuralgic amyotrophy (1). We here report a case of a 66-year old man with an unexpected diagnosis of HEV-associated GBS, illustrating the importance of including HEV in the differential diagnosis of neurological symptoms of unknown origin. His medical history is characterized by Parkinson’s disease and an end-to-end colostomy for rectal carcinoma. He presented to the emergency ward due to general malaise along with progressive hypoesthesia and slight weakness in both lower legs and feet. Despite a slight desaturation (91% on room air), the vital parameters were normal. Blood results showed liver abnormalities, which prompted additional laboratory testing leading to the diagnosis of acute hepatitis E (Table 1, Fig. 1).