Antiviral-Resistant Fulminant Herpes Hepatitis in Pregnancy

Herrera, Christina; Eichelberger, Kacey Y.; Chescheir, Nancy C.

doi:10.1055/s-0033-1343791

Cited by 10 publications

(3 citation statements)

References 19 publications

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“…While the patients in case 1 and 3 had near complete resolution of hepatitis within 5 days of initiation of acyclovir, unfortunately case 2 had rapid progression to fulminant hepatic failure and death, possibly because her disease burden was already too great on presentation or that the virus was acyclovir resistant. Though data is sparse, intravenous foscarnet is the agent of choice in cases of acyclovir-resistant herpetic infection; however even dual-agent therapy has proven ineffective in preventing mortality in previous case reports [ 9 ]. In general, the data also suggest that acyclovir should be started empirically for high-risk patients with ALF of unknown etiology, pending laboratory confirmation of the diagnosis.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease

Natu

Iuppa

Packer

2017

Case Reports in Hepatology

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Objective To compare three cases of Herpes simplex virus (HSV) hepatitis to increase early diagnosis of the disease. Case 1. A 23-year-old man with Crohn's disease and oral HSV. HSV hepatitis was diagnosed clinically and he improved with acyclovir. Case 2. An 18-year-old G1P0 woman with transaminitis. Despite early empiric acyclovir therapy, she died due to fulminant liver failure. Case 3. A 65-year-old woman who developed transaminitis after liver transplant. Diagnosis was confirmed by biopsy and she had resolution of acute liver failure with acyclovir. Conclusion It is imperative that clinicians be aware of patients at high risk for developing HSV hepatitis to increase timely diagnosis and prevent morbidity and fatality.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease

Natu

Iuppa

Packer

2017

Case Reports in Hepatology

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“…Abdominal pain combined with fever and hepatic dysfunction in pregnancy should prompt immediate consideration of the diagnosis of herpes hepatitis. 25 Laboratory analysis typically reveals elevated liver transaminases (up to 100 times the upper limit of normal), normal or mildly elevated bilirubin, leukopenia, and coagulopathy. Our patient’s pattern of liver injury, as well as her leukopenia and mild coagulopathy was consistent with this picture.…”

Section: Discussionmentioning

confidence: 99%

“…28 Serial HSV PCR levels can be measured to determine the magnitude of viremia and to detect resistance. 25 In the case of drug-resistant HSV infection, intravenous foscarnet can be considered, although it carries a significant risk of toxicity to the renal tubules and should be used only when there is high risk of mortality. 29 In cases of acute liver failure, liver transplantation should be considered early and immediate transfer to a liver transplant center is warranted.…”

Section: Discussionmentioning

confidence: 99%

A Spotty Liver of Pregnancy

Gray

Rockey

2014

Journal of Investigative Medicine High Impact Case Reports

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Herpes simplex virus (HSV) hepatitis by definition constitutes disseminated herpes simplex infection; it is rare, with only approximately 130 cases reported in the literature. Although HSV hepatitis typically occurs in immunocompromised hosts, pregnancy—especially the third trimester, has been identified as a risk factor for its development. This is likely because of the fact that humoral and cell-mediated immunity decrease throughout pregnancy and nadir in the third trimester with decreased T-cell counts and altered B/T lymphocyte ratios. Here, we report on a patient with HSV 2 hepatitis in a previously healthy 27-year-old woman in her 23rd week of pregnancy. She initially presented with nausea, vomiting, and abdominal pain and was found to have acute hepatocellular liver injury and a systemic inflammatory response syndrome. Broad-spectrum antibiotics and acyclovir were promptly initiated. Liver biopsy, serum DNA polymerase chain reaction (PCR) as well as a labial ulcer culture and PCR were all positive for HSV 2. The patient recovered completely; however, her fetus did not survive. Review of the literature emphasizes that presentation with disseminated HSV infection typically occurs in the third trimester of pregnancy. This report emphasizes that abdominal pain combined with fever and hepatic dysfunction in pregnancy should prompt immediate consideration of the diagnosis of HSV hepatitis. Furthermore, given the high mortality rate and effective treatment, empiric treatment with acyclovir should be considered early in all potential cases.

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Viral Infections in Obstetric Critical Care

Maves

2020

Principles and Practice of Maternal Critical Care

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Antiviral-Resistant Fulminant Herpes Hepatitis in Pregnancy

Cited by 10 publications

References 19 publications

Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease

Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease

A Spotty Liver of Pregnancy

Viral Infections in Obstetric Critical Care

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