Abstract
A 57 years old heavy vehicle driver had sudden onset shooting pain in the left upper limb that spread to the other side. He also noticed araesthesia of both his upper limbs. He had difficulties in lifting his arms above the shoulder. He also had exertional breathlessness. He had significant motor weakness of his upper limbs. Reflexes were absent in the upper limbs. He had no clear sensory abnormality or cerebellar signs. He was tachypnoeic . Hepatitis E IgM came back as positive. His hepatitis E RNA showed 1810 RNA units. The nerve conduction and EMG help us get the diagnosis as bilateral brachial neuritis associated with an acute HEV infection. Six weeks later, he returned with worsening orthopnea. He had paradoxical abdominal movements while lying flat. He developed bilateral diaphragmatic paresis during the sniff test. The chest X ray revealed that the domes of diaphragm were at the same level. He was discharged with non-Invasive ventilation.
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