Abstract Details

Title Hepatitis E virus infection and posterior reversible encephalopathy syndrome: a case report and review of the literature.

Topic Infectious Disease

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-014

Objective To describe a new neurological complication of hepatitis E virus infection.

Background

Hepatitis E virus (HEV) is an uncommon monophasic viral infection with primary hepatic involvement. Neurological complications have been reported with HEV infection, including acute polyradiculoneuropathy, meningitis, encephalitis, myelitis, and peripheral neuropathy. To date, this is the first reported case of HEV infection associated with posterior reversible encephalopathy syndrome (PRES).

Design/Methods A 66-year-old woman with a history of controlled hypertension and diabetes mellitus, migraine with aura, and prior spontaneous subarachnoid hemorrhage of indeterminate etiology was admitted to our institution for subacute onset of fatigue and malaise. She was found to have isolated elevation in hepatic enzymes (ALT: 1796 U/L; AST: 1308 U/L; AlkP: 204 U/L). An extensive hepatic workup was initially unrevealing. During her admission, she started complaining of right-sided headache and photophobia that subsequently precipitated into an acute confusional state accompanied by expressive aphasia. Infused brain MRI showed FLAIR abnormalities in the occipital lobes and cerebellum, along with a 1.5 cm left thalamic hemorrhage, compatible with PRES with associated intracerebral hemorrhage. Intracranial CTA and MRA did not show evidence of pathology to explain the brain findings. Her neurological status improved with supportive therapy and she was eventually discharged home. Further investigation revealed the presence of HEV IgM and IgG antibodies.

Results This patient presented with PRES and intracerebral hemorrhage in the context of an acute HEV infection. The timeframe, absence of other causative agents, and known neurological sequelae of HEV infection are suggestive of a correlation between the two diseases.

Conclusions

PRES could represent a new potential neurological complication of HEV infection. Its underlying pathophysiology remains uncertain and could be related either from a direct viral insult or a dysregulation in the immune system. Supportive treatment is recommended. In our case, the neurological outcome was benign with near complete recovery.

Authors/Disclosures
Andrea Loggini, MD, MPH MBA (Southern Illinois Healthcare) PRESENTER	Dr. Loggini has nothing to disclose.
	No disclosure on file
	No disclosure on file
Fulvio R. Gil, MD (Endeavor Health)	No disclosure on file

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