Case A 67 year old man presented with a febrile illness after returning from Goa, India. On the day of admission he developed severe shooting pain which radiated up his left arm, to his neck. The following day he was unable to dorsiflex his wrist or extend his fingers. He developed intermittent paraesthesia of his left forearm and wasting over the extensor aspect of the forearm. He was positive for hepatitis E IgM. On examination there was wasting in the left upper arm and forearm/hand. There was weakness of shoulder external rotation, mild weakness of elbow extension but severe weakness of wrist dorsiflexion, finger extension, abductor pollicis brevis and reduced sensation left C5.

Electrophysiological testing supported a diagnosis of left brachial plexopathy.

Discussion Brachial plexopathy is one of the many neurological manifestations of hepatitis E infection reported in the literature. A previous study has shown that acute hepatitis E infection was identified in 10% of patients with acute brachial plexopathy at the start of the illness.

Conclusion Acute hepatitis E infection is often subclinical and only associated with mild transient transaminitis. We suggest screening for hepatitis E infection in patients with acute neurology and concurrent liver enzyme derangement.