{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:02Z","timestamp":1756339562518,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,19]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2021-242113","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T14:49:05Z","timestamp":1618325345000},"page":"e242113","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Diaphragmatic paralysis resulting in respiratory failure as a feature of hepatitis E virus-associated neuralgic amyotrophy"],"prefix":"10.1136","volume":"14","author":[{"given":"Muhammed Ameen","family":"Noushad","sequence":"first","affiliation":[{"name":"Neurology, University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demetra","family":"Limnatitou","sequence":"additional","affiliation":[{"name":"Neurorehabilitation, University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shakya","family":"Bhattacharjee","sequence":"additional","affiliation":[{"name":"Neurology, University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azlisham","family":"Mohd Nor","sequence":"additional","affiliation":[{"name":"Neurology, University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"2025082710391364000_14.4.e242113.1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/14787210.2018.1446827","article-title":"Non-Traumatic neurological injury and hepatitis E infection","volume":"16","author":"Ripellino","year":"2018","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2025082710391364000_14.4.e242113.2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004297"},{"key":"2025082710391364000_14.4.e242113.3","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000000643","article-title":"Neurologic complications of acute hepatitis E virus infection","volume":"7","author":"Ripellino","year":"2020","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2025082710391364000_14.4.e242113.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2011.62"},{"key":"2025082710391364000_14.4.e242113.5","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2015.234"},{"key":"2025082710391364000_14.4.e242113.6","article-title":"A systematic review of the extra-hepatic manifestations of hepatitis E virus infection","volume":"8","author":"Rawla","year":"2020","journal-title":"Med Sci"},{"key":"2025082710391364000_14.4.e242113.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.005"},{"key":"2025082710391364000_14.4.e242113.8","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2019.00052","article-title":"Brain infection by hepatitis E virus probably via damage of the blood-brain barrier due to alterations of tight junction proteins","volume":"9","author":"Tian","year":"2019","journal-title":"Front Cell Infect Microbiol"},{"key":"2025082710391364000_14.4.e242113.9","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12557"},{"key":"2025082710391364000_14.4.e242113.10","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/mus.25096","article-title":"Hepatitis E virus infection as a direct cause of neuralgic amyotrophy","volume":"54","author":"Silva","year":"2016","journal-title":"Muscle Nerve"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:39:24Z","timestamp":1756316364000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,13]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2021-242113"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242113","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}