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Diaphragmatic paralysis resulting in respiratory failure as a feature of hepatitis E virus-associated neuralgic amyotrophy
  1. Muhammed Ameen Noushad1,
  2. Demetra Limnatitou2,
  3. Shakya Bhattacharjee1 and
  4. Azlisham Mohd Nor1
  1. 1Neurology, University Hospitals Plymouth NHS Trust, Plymouth, UK
  2. 2Neurorehabilitation, University Hospitals Plymouth NHS Trust, Plymouth, UK
  1. Correspondence to Dr Muhammed Ameen Noushad; muhammad.noushad{at}


Hepatitis E virus (HEV)-associated neuralgic amyotrophy (NA) is often bilateral and severe, involving structures outside the brachial plexus, such as the phrenic nerves or the lumbosacral plexus. We report a case of an HEV-positive man who had presented with brachial neuritis, with significant phrenic nerve involvement, resulting in diaphragmatic paralysis requiring non-invasive ventilation. Prognosis of HEV-associated NA is often unfavourable and recovery is usually incomplete. Identifying HEV-associated NA early could potentially aid in prognostication and management planning, as clinicians and patients would be expectant of its potential features and severity. Respiratory function should be monitored in patients with HEV who suffer from NA, as diaphragmatic paralysis could potentially lead to severe respiration difficulties requiring ventilatory support.

  • hepatitis and other GI infections
  • peripheral nerve disease

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  • Contributors MAN Draft and editing. DL Editing. AMN review. SB review

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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