Disseminated herpes simplex virus infection with misleading clinical presentation.

Haboubi, Najib; Sutton, R. N. P.; Craske, J.; Roberts, J

doi:10.1136/jcp.36.1.115

Cited by 4 publications

(1 citation statement)

References 2 publications

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“…In another case series evaluating infections in 6 heart transplant recipients, 3 patients had HSV infection, 1 with HSV hepatitis, and the other 2 cases with only mucocutaneous involvement . A small case series described HSV hepatitis occurring in a liver transplant and a kidney transplant recipient, in addition to a heart transplant recipient who was infected with HSV‐2 from reactivation (Table ) .…”

Section: Discussionmentioning

confidence: 99%

Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature

Pietrucha-Dilanchian

Tanawuttiwat

Abbo

et al. 2013

Transplant Infectious Dis

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Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature. Transpl Infect Dis 2013: 15: E87-E96. All rights reserved Abstract: Herpes simplex virus (HSV) hepatitis is often unrecognized clinically with most untreated cases diagnosed postmortem. HSV hepatitis has been reported in solid organ transplant (SOT) recipients, mostly in kidney and liver transplants, and rarely in heart transplant recipients. We describe a fatal case of community-acquired HSV-2 hepatitis in a 24-year-old heart transplant recipient occurring 3 years after transplant. We also review the literature summarizing HSV hepatitis and the potential role of quantitative HSV polymerase chain reaction monitoring in the SOT population.

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Section: Discussionmentioning

confidence: 99%

Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature

Pietrucha-Dilanchian

Tanawuttiwat

Abbo

et al. 2013

Transplant Infectious Dis

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Herpes simplex virus hepatitis: An analysis of the published literature and institutional cases

Norvell¹,

Blei²,

Jovanovic³

et al. 2007

Liver Transpl

237

318

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Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovirtreated patients as compared to 88% in the untreated subjects (P ϭ 0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age Ͼ40 yr, immunocompromised state, ALT Ͼ5,000 U/L, platelet count Ͻ75 ϫ 10 3 /L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.

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Fatal herpes simplex hepatitis type 2 in a post-thymectomized adult

et al. 1993

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The authors report an unusual case of herpes simplex type 2 (HSV) hepatitis which presented as part of a systemic HSV infection accompanied by disseminated intravascular coagulation (DIC). The patient was a 49-year-old Japanese male who three months prior to admission underwent surgical resection of his thymus for an invasive thymoma. Postoperatively, he received a course of chemotherapy which included prednisone, cyclophosphamide, vincristine, and pinorubicin. After discharge from the hospital, he was put on a maintenance dosage of prednisone and cyclophosphamide. Two weeks prior to this admission, the patient developed rhinorrhea, chills and general fatigue. Routine follow-up laboratory tests revealed markedly elevated liver enzymes which led to his immediate hospitalization. The tentative diagnosis on admission was fulminant hepatitis with DIC. The patient's condition steadily worsened during his hospitalization and acyclovir was initiated on the 4th hospital day due to the possibility of HSV hepatitis. He died on the same day. Histopathology performed on the liver at autopsy revealed hepatic inclusion bodies of HSV with positive immunohistochemical detection of the HSV type 2 antigen. Our case is the first report of HSV hepatitis associated with the removal of the thymus secondary to thymoma. It supports previous observations of disseminated HSV infection being prevalent in those patients with disorders of cell mediated immunity.

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Disseminated herpes simplex virus infection with misleading clinical presentation.

Abstract: Reactive lymph node. A cryostat section immunostained for IgM (TRITC) and counterstained with Gill's haematoxylin afterformalin fixation. Both haematoxylin nuclear staining (a) and IgM immunofluorescence (b)

Cited by 4 publications

References 2 publications

Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature

Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature

Herpes simplex virus hepatitis: An analysis of the published literature and institutional cases

Fatal herpes simplex hepatitis type 2 in a post-thymectomized adult

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