Beyond the liver: Hepatitis E virus-associated Guillain-Barré syndrome with respiratory failure in an adolescent, a case report.
TL;DR
HEV is an under-recognized trigger for severe GBS in adolescents, and should be considered in cases of acute flaccid paralysis presenting with concurrent hepatic dysfunction, where delayed diagnoses may result in poor clinical outcomes.
Abstract
Background
Hepatitis E virus (HEV) remains endemic worldwide, especially in resource-constrained settings. Although HEV-associated Guillain-Barré syndrome (GBS) is well documented in adults, severe presentations in adolescents are scarcely reported. CASE PRESENTATION A previously healthy 12-year-old female presented with progressive ascending weakness and rapidly progressive respiratory failure requiring mechanical ventilation. Acute hepatitis E infection was diagnosed based on positive anti-HEV IgM antibodies, confirmed by detection of HEV RNA on real-time reverse-transcriptase PCR (RT-PCR). Cerebrospinal fluid protein and cell count were normal, consistent with early-stage GBS. A diagnosis of HEV-associated GBS was made. Despite intravenous immunoglobulin therapy and intensive supportive care, the clinical course remained severe, and the patient ultimately died after withdrawal of care due to financial constraints.
Conclusion
HEV is an under-recognized trigger for severe GBS in adolescents, and should be considered in cases of acute flaccid paralysis presenting with concurrent hepatic dysfunction. Early recognition, therefore, remains paramount, particularly in resource-limited, endemic regions, where delayed diagnoses may result in poor clinical outcomes.