El virus de la hepatitis E en los trastornos neurológicos: un caso de síndrome de Parsonage-Turner

espanolLa infeccion por el virus de la hepatitis E (VHE) es una patologia emergente en paises industrializados y con un amplio espectro clinico. La hepatitis aguda, en ausencia de inmunocompromiso y embarazo, es una entidad leve y paucisintomatica en la mayoria de los pacientes. No obstante, las manifestaciones extrahepaticas, entre ellas las neurologicas, son frecuentes y en ocasiones conllevan secuelas neurologicas permanentes. Reportamos el caso de un paciente inmunocompetente que ingresa por cuadro de parestesias y debilidad en ambas extremidades superiores asociado a elevacion anicterica de transaminasas. El diagnostico, mediante electromiograma y serologias, fue de sindrome de Parsonage-Turner (neuralgia amiotrofica) secundario a VHE. La neuralgia amiotrofica (NA) es una patologia axonal desmielinizante que afecta al plexo braquial y se asocia al VHE hasta en un 10% de los casos. Recalcamos la importancia de solicitar serologias del VHE en pacientes con patologia neurologica, especialmente con afectacion del sistema nervioso periferico. El papel de la ribavirina en estos escenarios esta pendiente de esclarecer; no obstante, el diagnostico y tratamiento precoz podria suponer una mejoria pronostica, minimizando las secuelas neurologicas. EnglishHepatitis E virus (HEV) infection is an emerging disease in developed countries with a broad clinical spectrum. In the absence of immunodeficiency or pregnancy, it is a mild and almost asymptomatic condition in most cases. However, extrahepatic manifestations, including neurological conditions, are common and may occasionally lead to permanent neurological sequelae. Herein, we report the case of an immunocompetent patient who was admitted to our hospital with paresthesia and weakness in both the upper extremities associated with anicteric-elevated transaminases. The diagnosis was Parsonage-Turner syndrome (neuralgic amyotrophy) secondary to HEV infection. The diagnosis was reached via electromyography and serology tests. Neuralgic amyotrophy (NA) is a demyelinating axonal disease that affects the brachial plexus and is associated with HEV infection in up to 10% of cases. We also emphasize the importance of requesting HEV serology in patients with neurological disease, especially with the involvement of the peripheral nervous system. Although the role of ribavirin remains to be fully determined, early diagnosis and treatment may result in an improved prognosis, thereby minimizing neurological sequelae.