Abstract Details

Title Acute Hepatitis E Virus Infection Presenting as Stimulus-induced Status Epilepticus

Topic Infectious Disease

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-014

Objective NA

Background Hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide, with an expanding range of extrahepatic manifestations involving both central and peripheral nervous systems. Neurological complications such as Guillain-Barré syndrome, neuralgic amyotrophy, encephalitis, and myelitis have been described; however, status epilepticus has not been previously associated with HEV infection. We report the first documented case of acute HEV-induced stimulus-triggered status epilepticus, highlighting the virus’s neurotropic potential and underscoring the importance of considering infectious causes in unexplained seizures accompanied by hepatic dysfunction and elevated liver enzymes.

Design/Methods A 58-year-old previously healthy woman presented with new-onset focal seizures that progressed to bilateral clonic status epilepticus, refractory to multiple antiseizure regimens. Continuous EEG monitoring confirmed persistent electrographic seizures reproducibly provoked by tactile and auditory stimuli. Laboratory studies showed markedly elevated aminotransferases (AST 621 IU/L, ALT 491 IU/L) and positive HEV IgM confirmed by real-time PCR. Other infectious, autoimmune, metabolic, and toxic evaluations were unremarkable. Brain MRI demonstrated right mesial temporal hyperintensity consistent with focal cortical edema due to prolonged seizures, while cerebrospinal fluid analysis revealed mild protein elevation with normal cell counts, suggesting non-encephalitic cortical involvement without inflammatory changes.

Results The patient developed super-refractory status epilepticus requiring mechanical ventilation, anesthetic infusions, and therapeutic hypothermia. Despite eventual resolution of electrographic seizures and normalization of hepatic enzymes, she evolved into a vegetative state. This course supports a possible direct or immune-mediated neuroinvasive mechanism of HEV infection, consistent with evidence of viral replication within the central nervous system and disruption of the blood–brain barrier in experimental animal models.

Conclusions

This case broadens the recognized neurological spectrum of HEV to include stimulus-induced status epilepticus. Incorporating HEV serology and PCR into the diagnostic work-up of unexplained seizures or encephalitis with abnormal liver enzymes may facilitate earlier diagnosis, targeted management, and improved neurologic outcomes.

Authors/Disclosures
Nsser Abdelall, MD (LSU Health Sciences - CALS Bldg) PRESENTER	Dr. Abdelall has nothing to disclose.
Farah Alkilani, MD	Dr. Alkilani has nothing to disclose.
Abdulradha Alqallaf, MD (Amiri Hospital)	Dr. Alqallaf has nothing to disclose.

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