We report a case of a 38 year old woman with a rapidly progressive weakness (initially affecting the lower limbs) and urine retention following a prodromal viral illness. Her reflexes were brisk. She developed upper limb weakness and a sensory level at T2 as well as respiratory compromise requiring intensive care monitoring and treatment.

Treatment with intravenous immunoglobulin (IVIG), methylprednisolone and plasma exchange resulted in significant improvement of upper limb function, but unfortunately there was no substantial improvement in lower limb or bladder function. This case highlights a rarely reported cause of cord inflammation. Treatment of Hepatitis E is not normally needed in immunocompetent patients, but an important question, and a potential area of future research, is whether antiviral agents like ribavirin, in addition to immunotherapies, would improve outcomes in acute Hepatitis E-associated transverse myelitis.