{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T23:52:18Z","timestamp":1794268338195,"version":"4.9.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Open Access Funding by the Publication Fund of the TU Dresden","award":["IN-1502335"],"award-info":[{"award-number":["IN-1502335"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis E infection affects over 20 million people worldwide. Reports of neurological manifestations are largely limited to the peripheral nervous system. We report a middle-aged genotype 3c male patient with acute hepatitis E virus (HEV) infection and severe neurological deficits with evidence of multiple disseminated inflammatory lesions of the central nervous system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 42-year-old male patient presented to our emergency department with musculoskeletal weakness, bladder and bowel retention, blurred vision and ascending hypoesthesia up to the level of T8. Serology showed elevated liver enzymes and positive IgM-titers of hepatitis E. Analysis of cerebrospinal fluid (CSF) showed mild pleocytosis and normal levels of glucose, lactate and protein. HEV-RNA-copies were detected in the CSF and stool. Within 3 days after admission the patient became paraplegic, had complete visual loss and absent pupillary reflexes. MRI showed inflammatory demyelination of the optic nerve sheaths, multiple subcortical brain regions and the spinal cord. Electrophysiology revealed axonal damage of the peroneal nerve on both sides with absent F-waves. Treatment was performed with methylprednisolone, two cycles of plasma exchange (PLEX), one cycle of intravenous immunoglobulins (IVIG) and ribavirin which was used off-label. Liver enzymes normalized after 1 week and serology was negative for HEV-RNA after 3 weeks. Follow-up MRI showed progressive demyelination and new leptomeningeal enhancement at the thoracic spine and cauda equina 4 weeks after admission. Four months later, after rehabilitation was completed, repeated MRI showed gliotic transformation of the spinal cord without signs of an active inflammation. Treatment with rituximab was initiated. The patient remained paraplegic and hypoesthesia had ascended up to T5. Nevertheless, he regained full vision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our case indicates a possible association of acute HEV infection with widespread disseminated central nervous system inflammation. Up to now, no specific drugs have been approved for the treatment of acute HEV infection. We treated our patient off-label with ribavirin and escalated immunomodulatory therapy considering clinical progression and the possibility of an autoimmune response targeting nerve cell structures.<\/jats:p>\n                    <jats:p>While response to treatment was rather limited in our case, detection of HEV in patients with acute neurological deficits might help optimize individual treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-020-01952-5","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T06:04:01Z","timestamp":1603778641000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Disseminated inflammation of the central nervous system associated with acute hepatitis E: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Jan","family":"Rahmig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Grey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Berning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Schaefer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lesser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Reichmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Puetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Barlinn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Siepmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"1952_CR1","doi-asserted-by":"publisher","unstructured":"Kamar N, Izopet J, Pavio N, Aggarwal R, Labrique A, Wedemeyer H, Dalton HR. Hepatitis E virus infection. Nat Rev Dis Primers. 2017;3:17086. https:\/\/doi.org\/10.1038\/nrdp.2017.86.","DOI":"10.1038\/nrdp.2017.86"},{"key":"1952_CR2","doi-asserted-by":"publisher","unstructured":"Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55(4):988\u201397. https:\/\/doi.org\/10.1002\/hep.25505.","DOI":"10.1002\/hep.25505"},{"key":"1952_CR3","doi-asserted-by":"publisher","unstructured":"Pischke S, Behrendt P, Bock T, Jilg W, Manns M, Wedemeyer H. Hepatitis E in Deutschland eine untersch\u00e4tzte Infektionskrankheit. Dtsch Arztebl Int. 2014;111:577\u201383. https:\/\/doi.org\/10.3238\/arztebl.2014.0577.","DOI":"10.3238\/arztebl.2014.0577"},{"key":"1952_CR4","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1111\/j.1440-1746.2009.05933.x","volume":"24","author":"R Aggarwal","year":"2009","unstructured":"Aggarwal R, Naik S. Epidemiology of hepatitis E: current status. J Gastroenterol Hepatol. 2009;24:1484\u201393. https:\/\/doi.org\/10.1111\/j.1440-1746.2009.05933.x.","journal-title":"J Gastroenterol Hepatol"},{"key":"1952_CR5","doi-asserted-by":"publisher","unstructured":"Wedemeyer H, Pischke S, Manns MP. Pathogenesis and treatment of hepatitis e virus infection. Gastroenterology. 2012;142(6):142(6):1388-97.e1 https:\/\/doi.org\/10.1053\/j.gastro.2012.02.014.","DOI":"10.1053\/j.gastro.2012.02.014"},{"key":"1952_CR6","doi-asserted-by":"publisher","unstructured":"Schielke A, Ibrahim V, Czogiel I, et al. Hepatitis E virus antibody prevalence in hunters from a district in Central Germany, 2013: a cross-sectional study providing evidence for the benefit of protective gloves during disembowelling of wild boars. BMC Infect Dis. 2015;15:440. https:\/\/doi.org\/10.1186\/s12879-015-1199-y.","DOI":"10.1186\/s12879-015-1199-y"},{"key":"1952_CR7","doi-asserted-by":"publisher","unstructured":"Zhang J, Zhang XF, Huang SJ, Wu T, Hu YM, Wang ZZ, Wang H, Jiang HM, Wang YJ, Yan Q, Guo M, Liu XH, Li JX, Yang CL, Tang Q, Jiang RJ, Pan HR, Li YM, Shih JW, Ng MH, Zhu FC, Xia NS. Long-term efficacy of a hepatitis E vaccine. N Engl J Med. 2015;372(10):914-22. https:\/\/doi.org\/10.1056\/NEJMoa1406011.","DOI":"10.1056\/NEJMoa1406011"},{"key":"1952_CR8","doi-asserted-by":"publisher","unstructured":"Feng-Cai Z, Jun Z, Xue-Feng Z, Cheng Z, Zhong-Ze W, Shou-Jie H, Hua W, Chang-Lin Y, Han-Min J, Jia-Ping C, Yi-Jun W, Xing A, Yue-Mei H, Quan T, Xin Y, Qiang Y, Yang-Ling X, Ting W, Yi-Min L, Ji M, Mun-Hon N, James Wai-Kuo S, Ning-Shao X. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet. 2010;376(9744):895-902. https:\/\/doi.org\/10.1016\/S0140-6736(10)61030-6.","DOI":"10.1016\/S0140-6736(10)61030-6"},{"key":"1952_CR9","doi-asserted-by":"publisher","unstructured":"Ripellino P, Pasi E, Melli G, Staedler C, Fraga M, Moradpour D, Sahli R, Aubert V, Martinetti G, Bihl F, Bernasconi E, Terziroli Beretta-Piccoli B, Cerny A, Dalton HR, Zehnder C, Mathis B, Zecca C, Disanto G, Kaelin-Lang A, Gobbi C. Neurologic complications of acute hepatitis E virus infection. Neurol Neuroimmunol Neuroinflamm. 2019;7(1):e643. https:\/\/doi.org\/10.1212\/NXI.0000000000000643.","DOI":"10.1212\/NXI.0000000000000643"},{"key":"1952_CR10","doi-asserted-by":"publisher","unstructured":"van den Berg B, van der Eijk AA, Pas SD, Hunter JG, Madden RG, Tio-Gillen AP, Dalton HR, Jacobs BC. Guillain-Barr\u00e9 syndrome associated with preceding hepatitis E virus infection. Neurology. 2014;82(6):491-7. https:\/\/doi.org\/10.1212\/WNL.0000000000000111.","DOI":"10.1212\/WNL.0000000000000111"},{"key":"1952_CR11","doi-asserted-by":"publisher","unstructured":"Bisciglia M, Van den Bergh P, Duprez T, Kabamba BM, Ivanoiu A. Neuralgic amyotrophy associated with hepatitis E virus (HEV) infection: a case report. Acta Neurol Belg. 2017;117(2):555-7. https:\/\/doi.org\/10.1007\/s13760-016-0642-1.","DOI":"10.1007\/s13760-016-0642-1"},{"key":"1952_CR12","doi-asserted-by":"publisher","unstructured":"Jha AK, Nijhawan S, Nepalia S, Suchismita A. Association of Bell's Palsy with Hepatitis E Virus Infection: A Rare Entity. J Clin Exp Hepatol. 2012;2(1):88-90. https:\/\/doi.org\/10.1016\/S0973-6883(12)60082-6.","DOI":"10.1016\/S0973-6883(12)60082-6"},{"key":"1952_CR13","doi-asserted-by":"publisher","unstructured":"Wang L, Gao F, Lin G, Yuan Y, Huang Y, Hao H, Zhuang H, Wang L. Association of hepatitis E virus infection and myasthenia gravis: A pilot study. J Hepatol. 2018;68(6):1318-20. https:\/\/doi.org\/10.1016\/j.jhep.2018.01.040.","DOI":"10.1016\/j.jhep.2018.01.040"},{"key":"1952_CR14","doi-asserted-by":"publisher","unstructured":"Kejariwal D, Roy S, Sarkar N. Seizure associated with acute hepatitis E. Neurology. 2001;57(10):1935. https:\/\/doi.org\/10.1212\/wnl.57.10.1935.","DOI":"10.1212\/wnl.57.10.1935"},{"issue":"4","key":"1952_CR15","first-page":"365","volume":"43","author":"K Mandal","year":"2006","unstructured":"Mandal K, Chopra N. Acute transverse myelitis following hepatitis E virus infection. Indian Pediatr. 2006;43(4):365\u20136.","journal-title":"Indian Pediatr"},{"key":"1952_CR16","doi-asserted-by":"publisher","first-page":"bcr2014209031","DOI":"10.1136\/bcr-2014-209031","volume":"2015","author":"P Sarkar","year":"2015","unstructured":"Sarkar P, Morgan C, Ijaz S. Transverse myelitis caused by hepatitis E: previously undescribed in adults. BMJ Case Rep. 2015;2015:bcr2014209031.","journal-title":"BMJ Case Rep"},{"issue":"5","key":"1952_CR17","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/j.jhep.2016.11.016","volume":"66","author":"S Pischke","year":"2017","unstructured":"Pischke S, Hartl J, Pas SD, Lohse AW, Jacobs BC, Van der Eijk AA. Hepatitis E virus: infection beyond the liver? J Hepatol. 2017;66(5):1082\u201395.","journal-title":"J Hepatol"},{"key":"1952_CR18","doi-asserted-by":"publisher","unstructured":"Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty\u2019s Stationery Office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O\u2019Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 Figures. Brain. 2010;133(10):2838\u201344. https:\/\/doi.org\/10.1093\/brain\/awq270.","DOI":"10.1093\/brain\/awq270"},{"key":"1952_CR19","doi-asserted-by":"publisher","unstructured":"Marinou Aktipi K, Ravaglia S, Ceroni M, Nemni R, Debiaggi M, Bastianello S, Alfonsi E, Zardini E, Minoli L, Tavazzi E, Marchioni E. Severe recurrent myelitis in patients with hepatitis C virus infection. Neurology. 2007;68(6):468\u20139. https:\/\/doi.org\/10.1212\/01.wnl.0000252931.77486.1a.","DOI":"10.1212\/01.wnl.0000252931.77486.1a"},{"key":"1952_CR20","doi-asserted-by":"publisher","unstructured":"Trevisani F, Gattinara GC, Caraceni P, Bernardi M, Albertoni F, D'Alessandro R, Elia L, Gasbarrini G. Transverse myelitis following hepatitis B vaccination. J Hepatol. 1993;19(2):317-8. https:\/\/doi.org\/10.1016\/s0168-8278(05)80589-6.","DOI":"10.1016\/s0168-8278(05)80589-6"},{"key":"1952_CR21","doi-asserted-by":"publisher","unstructured":"Tyler KL, Gross RA, Cascino GD. Unusual viral causes of transverse myelitis: hepatitis A virus and cytomegalovirus. Neurology. 1986;36(6):855-8. https:\/\/doi.org\/10.1212\/wnl.36.6.855.","DOI":"10.1212\/wnl.36.6.855"},{"key":"1952_CR22","doi-asserted-by":"publisher","unstructured":"Stubgen J-P. Immune-mediated myelitis associated with Hepatitis virus infections. J Neuroimmunol. 2011;239(1\u20132):21-27. https:\/\/doi.org\/10.1016\/j.jneuroim.2011.09.001.","DOI":"10.1016\/j.jneuroim.2011.09.001"},{"issue":"11","key":"1952_CR23","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1001\/archneur.62.11.1673","volume":"62","author":"T Menge","year":"2005","unstructured":"Menge T, Hemmer B, Nessler S, et al. Acute disseminated encephalomyelitis: an update. Arch Neurol. 2005;62(11):1673\u201380. https:\/\/doi.org\/10.1001\/archneur.62.11.1673.","journal-title":"Arch Neurol"},{"key":"1952_CR24","doi-asserted-by":"publisher","first-page":"217","DOI":"10.3389\/fneur.2018.00217","volume":"9","author":"GR Dos Passos","year":"2018","unstructured":"Dos Passos GR, Oliveira LM, da Costa BK, et al. MOG-IgG-Associated Optic Neuritis, Encephalitis, and Myelitis: Lessons Learned From Neuromyelitis Optica Spectrum Disorder. Front Neurol. 2018;9:217. https:\/\/doi.org\/10.3389\/fneur.2018.00217 Published 2018 Apr 4.","journal-title":"Front Neurol"},{"key":"1952_CR25","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1046\/j.1440-1754.2003.00154.x","volume":"39","author":"G Gupte","year":"2003","unstructured":"Gupte G, Stonehouse M, Wassmer E, Coad N, Whitehouse W. Acute disseminated encephalomyelitis: a review of 18 cases in childhood. J Paediatr Child Health. 2003;39:336\u201342. https:\/\/doi.org\/10.1046\/j.1440-1754.2003.00154.x.","journal-title":"J Paediatr Child Health"},{"key":"1952_CR26","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1007\/s00115-004-1842-0","volume":"76","author":"O St\u00fcve","year":"2005","unstructured":"St\u00fcve O, Nessler S, Hartung HP, et al. Akute disseminierte Enzephalomyelitis. Nervenarzt. 2005;76:701\u20137. https:\/\/doi.org\/10.1007\/s00115-004-1842-0.","journal-title":"Nervenarzt"},{"key":"1952_CR27","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000187","volume":"3","author":"R Magun","year":"2016","unstructured":"Magun R, Verschoor CP, Bowdish DME, et al. Mycoplasma pneumoniae, a trigger for Weston Hurst syndrome. Neurol Neuroimmunol Neuroinflamm. 2016;3:e187. https:\/\/doi.org\/10.1212\/NXI.0000000000000187.","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"1952_CR28","doi-asserted-by":"crossref","unstructured":"Byers RK. Acute hemorrhagic leukoencephalitis: report of three cases and review of the literature. Pediatrics. 1975;56:727\u201335.","DOI":"10.1542\/peds.56.5.727"},{"key":"1952_CR29","doi-asserted-by":"publisher","unstructured":"Gerolami R, Borentain P, Raissouni F, Motte A, Solas C, Colson P. Treatment of severe acute hepatitis E by ribavirin. J Clin Virol. 2011;52(1):60-2. https:\/\/doi.org\/10.1016\/j.jcv.2011.06.004.","DOI":"10.1016\/j.jcv.2011.06.004"},{"key":"1952_CR30","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.tim.2013.10.005","volume":"22","author":"Z Feng","year":"2013","unstructured":"Feng Z, Lemon SM. Peek-a-boo: membrane hijacking and the pathogenesis of viral hepatitis. Trends Microbiol. 2013;22:59\u201364.","journal-title":"Trends Microbiol"},{"key":"1952_CR31","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1111\/j.1600-6143.2010.03068.x","volume":"10","author":"N Kamar","year":"2010","unstructured":"Kamar N, Izopet J, Cintas P, et al. Hepatitis E virusinduced neurological symptoms in a kidney-transplant patient with chronic hepatitis. Am J Transplant. 2010;10:1321\u20134.","journal-title":"Am J Transplant"},{"issue":"4","key":"1952_CR32","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1111\/liv.13085","volume":"36","author":"Z Feng","year":"2016","unstructured":"Feng Z. Causation by HEV of extrahepatic manifestations remains unproven. Liver Int. 2016;36(4):477\u20139. https:\/\/doi.org\/10.1111\/liv.13085.","journal-title":"Liver Int"},{"key":"1952_CR33","doi-asserted-by":"publisher","first-page":"bcr2016217215","DOI":"10.1136\/bcr-2016-217215","volume":"2016","author":"S Nabi","year":"2016","unstructured":"Nabi S, Badshah M, Ahmed S, Nomani AZ. Weston-Hurst syndrome: a rare fulminant form of acute disseminated encephalomyelitis (ADEM). BMJ Case Reports. 2016;2016:bcr2016217215.","journal-title":"BMJ Case Reports"},{"issue":"2","key":"1952_CR34","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1155\/1992\/531837","volume":"3","author":"RK Chaudhary","year":"1992","unstructured":"Chaudhary RK, Andonov AP. Effect of ribavirin on hepatitis A virus replication in vitro. Can J Infect Dis. 1992;3(2):67\u201370. https:\/\/doi.org\/10.1155\/1992\/531837 PMID: 22529734; PMCID: PMC3328025.","journal-title":"Can J Infect Dis"},{"key":"1952_CR35","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1002\/hep.1840180206","volume":"18","author":"S Kakumu","year":"1993","unstructured":"Kakumu S, Yoshioka K, Wakita T, Ishikawa T, Takayanagi M, Higashi Y. Pilot study of ribavirin and interferon-\u00e2 for chronic hepatitis B. Hepatology. 1993;18:258\u201363.13.","journal-title":"Hepatology"},{"key":"1952_CR36","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/S0168-8278(05)80387-3","volume":"21","author":"MW Fried","year":"1994","unstructured":"Fried MW, Fong T-L, Swain MG, Park Y, Beames MP, Banks SM, et al. Therapy of chronic hepatitis B with a 6-month course of ribavirin. J Hepatol. 1994;21:145\u201350.","journal-title":"J Hepatol"},{"issue":"2","key":"1952_CR37","doi-asserted-by":"publisher","first-page":"123","DOI":"10.4254\/wjh.v8.i2.123","volume":"8","author":"V Loustaud-Ratti","year":"2016","unstructured":"Loustaud-Ratti V, Debette-Gratien M, Jacques J, et al. Ribavirin: past, present and future. World J Hepatol. 2016;8(2):123\u201330. https:\/\/doi.org\/10.4254\/wjh.v8.i2.123.","journal-title":"World J Hepatol"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-020-01952-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-020-01952-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-020-01952-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T17:37:28Z","timestamp":1669311448000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-020-01952-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,27]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1952"],"URL":"https:\/\/doi.org\/10.1186\/s12883-020-01952-5","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,27]]},"assertion":[{"value":"11 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"391"}}