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Table 2 Clinical and diagnostic features of patients with an acute HEV infection

From: Hepatitis E virus as a trigger for Guillain-Barré syndrome

  Patient 1 Patient 2
Age, sex 56, female 65, male
Subtype AMSAN Classical GBS
Symptoms
 Cranial Nerves Diplopia, right-sided trigeminal hypesthesia
 Motor Flaccid tetraparesis, areflexia Slight weakness in both arms, areflexia
 Sensory Hypesthesia of both legs Hypesthesia of distal extremities, pallhypesthesia with gait ataxia
 Autonomic Reduced vital capacity
GBS disability index
 Nadir 5 2
 Discharge 4 1
Time from symptom onset to analysis 6 weeks 5.5 weeks
Medical History Type 2 diabetes, arterial hypertension, hypercholesterolemia, diabetic polyneuropathy, vitamin B12 deficiency, alcohol abuse, chronic pancreatitis, former Hepatitis A and B infection, former pontine stroke Arterial hypertension, monoclonal gammopathy type IgG lambda
Travel history None None
HEV Status
 Serology
  IgM (AU/ml) Positive (7.54) Positive (1.06)
  IgG (AU/ml) Positive (17.78) Positive (14.60)
  PCR serum/CSF Negative/negative Negative/negative
CSF
  WBC (/μl) 3 3
  Protein (mg/l) 448 600 (↑)
  QAlb (×10−3) 7.2 7.1
Liver function tests
 AST (U/l) 24 37
 ALT (U/l) 10 40
Antibodies
 (GM1,GQ1b, GD1) Negative Not available
Electrophysiology
 Demyelination ++
 Axonal Damage ++ +
  1. Normal range: AST/ALT: female 10–35 U/l, male 10–50 U/l, CSF: WBC < 5/μl, total protein < 450 mg/l, QAlb: 15–40 years 6.5 × 10− 3, 40–59 years 8 × 10− 3, 60–79 years 9.3 × 10− 3
  2. ALT Alanine Aminotransferase, AST Aspartate Aminotransferase, CSF cerebrospinal fluid, HEV Hepatitis E Virus, PCR polymerase chain reaction, QAlb quotient of albumin, WBC white blood cell count