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GUILLAIN-BARRE SYNDROME AS AN EXTRAHEPATIC MANIFESTATION IN ACUTE HEPATITIS E VIRUS INFECTION

Clara Rodriguez Carrillo 1, Sara Molino Tejedor 1, Yaiza Altuzarra Ranedo 1, Jesús Sánchez César 1, María Machín Delgado 1, Isabel Cacho Soblechero 1, Clara López Martínez 1, Maria Elena Aznar Ruiz 1, Guillermo Carranza Granero 1, Manuel Holgado Ayuso 1, JUAN LUIS MENDOZA 1

Affiliations

1 Hospital Clinico San Carlos, Madrid, Spain

Summary

AI Generated

A clinical case report describes Guillain-Barré Syndrome as a rare neurological manifestation of Hepatitis E Virus infection following deer meat consumption, with successful treatment using intravenous immunoglobulins.

A 58-year-old patient presented with progressive lower limb weakness, jaundice, elevated liver enzymes, and positive HEV serology after consuming deer meat five weeks prior.
Neurological manifestations occur in 55% of extrahepatic HEV involvement, with Guillain-Barré Syndrome, amyotrophic neuralgia, and meningoencephalitis being the most frequent presentations.
Diagnosis was established based on symmetrical weakness, abolished reflexes, albumin-cytological dissociation in cerebrospinal fluid, and electromyogram findings compatible with motor radiculopathy.
Treatment with intravenous immunoglobulins 0.4g/kg for 5 days resulted in progressive clinical and analytical improvement.
In developed countries, HEV is considered an emerging zoonosis linked to consumption of animal meat including pigs, wild boars, and deer, with complete recovery occurring in around 60% of GBS cases.

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Abstract

Clinical Case Summary

Neurological manifestations in Hepatitis E Virus (HEV) infection are rare. Even so, they constitute the most frequent extrahepatic involvement (55%). The most frequent neurological presentations are amyotrophic neuralgia, Guillain-Barré Syndrome (GBS) and meningoencephalitis.
A 58-year-old presents 2 week's progressive weakness of the lower limbs and jaundice. Blood tests show elevated liver enzymes and hyperbilirubinemia; with no signs of liver insufficiency. Serologies show positivity for HEV IgG and IgM. The patient confesses game meat (deer) consume in the prior 5 weeks.
The neurological examination reveals a general decrease in symmetrical strength, with abolished musculoskeletal reflexes. After normal CT, cerebrospinal fluid discloses albumin-cytological dissociation. The electromyogram is compatible with motor radiculopathy. Diagnosis of GBS is stablished and so, immediate iv immunoglobulins 0.4g/kg are administered for 5 days, with progressive analytical and clinical improvement.
HEV is the main cause of acute viral hepatitis in humans. Infection in endemic areas is generally related to the consumption of contaminated water. In contrast, in developed countries, sporadic cases are frequently described and linked to the consumption of animal meat (pigs, wild boars and deer). Thus, HEV is currently considered an emerging zoonosis.
Most cases are asymptomatic, with spontaneous clearance in most healthy subjects. As with any hepatitis, it frequently presents as painless jaundice and asthenia.
The association with GBS is well established. An immune-mediated mechanism has been postulated as the immediate cause. Supportive treatment with immunoglobulins, plasmapheresis, steroids and physical therapy are generally used. The use of ribavirin is reserved for acute fulminant hepatitis or chronic hepatitis cases.
The course is usually satisfactory with complete recovery around 60% of patients.

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Clinical Case

Session

Clinical cases in HPB (Posters)

Published

2024

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Marianna Arvanitakis 1

Affiliations

1 ERASME University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Abstract

Event

UEG Week Barcelona 2026

Topics

Pancreas Hepatobiliary Endoscopy

Session

Mistakes in… Hepatobiliary and pancreas

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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MAPS III guidelines: What’s next?

Mario Dinis-Ribeiro 1

Affiliations

1 IPO Porto, Porto, Portugal

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Abstract

Event

UEG Week Barcelona 2026

Topics

Immunology Stomach & H. Pylori Oesophagus Digestive Oncology

Session

Management of upper GI: Precancerous conditions and early neoplasia

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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Optimised management of alcohol-related liver disease: From alcohol rehabilitation to liver transplantation

Elisa Pose 1

Affiliations

1 Hospital Clínic of Barcelona - IDIBAPS, Barcelona, Spain

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Surgery Radiology & Imaging Immunology Hepatobiliary

Session

Avoid inflammation and intoxication: Management of autoimmune and alcohol-related liver disease

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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Manuela Merli

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Teamwork at the tip: Nursing excellence in endoscopic resection (OLYMPUS EUROPA SE & CO. KG )

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Abstract

Event

UEG Week Barcelona 2026

Topics

Nurses

Session

New trends and developments in endoscopic techniques

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Introduction: Advanced chronic liver disease: When the liver gets stiff, the complications get going

Mattias Mandorfer 1

Affiliations

1 Medical University of Vienna, Vienna, Austria

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Digestive Oncology Radiology & Imaging Small Intestine & Nutrition Hepatobiliary

Session

Advanced chronic liver disease: When the liver gets stiff, the complications get going

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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EVALUATION OF NUTRITIONAL STATUS AND DIETARY INTAKE IN PATIENTS WITH LIVER CIRRHOSIS: A REAL-LIFE STUDY IN OUTPATIENTS AND HOSPITALIZED SUBJECTS

Saniya Khan 1, Sara Sansoni 1, Simone Di Cola 1, Lucia Lapenna 1, Manuela Merli 1

Affiliations

1 Sapienza University, Rome, Italy

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Abstract

Introduction

Malnutrition and sarcopenia are two very frequent complications in patients with liver cirrhosis (LC). These conditions are associated with increased morbidity and mortality, particularly in advanced stages and require early investigation. Despite their significant impact on the prognosis, they are often overlooked and underdiagnosed.

Aims & Methods

Aim: To provide a general overview regarding the nutritional status and dietary intake in patients with LC and highlight any disparities in nutritional parameters between outpatients and hospitalized LC patients.
Methods: In this prospective observational study, all consecutive LC patients attending the portal hypertension clinic and those admitted to the gastroenterology ward at Policlinico Umberto I from May 2023 to January 2024 underwent nutritional screening. Demographic information, clinical characteristics, SARC-F questionnaire, anthropometric measurements, liver frailty index (LFI) parameters, 24-hour diet recall, and food frequency questionnaire were included in the screening. Data was analyzed using Student’s t-test and chi-square test by Jamovi software version 2.3.28.

Results

Altogether 126 patients [male- 72.2%; age 63.7±10.7 years; etiology: Alcohol-53%, MASLD-19%, Viral-20%, Others-8%; MELD- 11.8±4.4; MELD Na- 13.6±5.5; 50% Child A] were enrolled. 36% of the patients were sarcopenic according to SARC-F questionnaire (score ≥ 4), with a mean LFI of 4.6±0.9. Although 65% of the patients consumed at least one protein source daily, only 15% achieved recommended daily protein intake, and 78% had lower energy intake than recommended. Of these 126 patients, 68.3% were outpatient and 31.7% were hospitalized, with comparable age and gender distribution. Hospitalized patients had a lower BMI (kg/m²) [24.7±4.1 vs 27.8±6.9; p=0.01], higher prevalence of frailty [5.1±1.1 vs 4.3±0.7; p=<0.001], lower TSF (mm) [12.4±6.8 vs 16.2±8.1; p=0.04], and lower MUAC (cm) [29.6±5.1 vs 32.2±5.6; p=0.02] than outpatients. Further, none of the hospitalized patients met adequate protein intake, contrasting with 22% of outpatients (p=0.01).

Table 1: Comparison between outpatient and hospitalized patients

Variables	Outpatient (n=86)	Hospitalized patients (n=40)	p value
Age (years)	64.2 ± 9.8	62.6 ± 12.3	0.4
Gender (male)	68.6%	80%	0.1
BMI (kg/m²)	27.8 ± 6.9	24.7 ± 4.1	0.01
MELD	10.5 ± 3.4	14.7 ± 5.2	<.001
MELD-Na	11.9 ± 6.1	17 ± 4.4	<.001
CTP	A: 60% B: 39% C: 1%	A: 25% B: 50% C: 25%	<.001
Hand grip strength (kg)	22.3 ± 8.7	24.6 ± 9.1	0.4
Chair stands (sec)	14.4 ± 5.3	15.6 ± 4.6	0.4
LFI Robust (≤ 3.2) Pre-frail (3.3-4.4) Frail (≥ 4.5)	4.3 ± 0.7 5% 54% 40%	5.1 ± 1.1 0 38% 62%	<.001 0.06

Conclusion

The impairment of nutritional status tend to increase in the more advanced stages of liver disease. There is a need for timely and routine assessment of nutritional status and implementation of targeted lifestyle interventions to optimize patient outcomes.

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

Aspects in managing cirrhosis (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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