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

Abstract

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.

Herpes simplex virus 2 hepatitis in a lung transplant recipient: a diagnostic challenge

“…In the majority of the reported cases, the infection is attributed either to a primary infection, or to reactivation under intensive immunosuppressive treatment. Exceptional cases of graft transmission have been reported . In our case, the 4‐year duration since LT argues against graft transmission.…”

“…In retrospect, the unexplained micronodular aspect on the liver computed tomography scan should have drawn our attention. This nonspecific aspect has already been described and represents foci of hepatic necrosis secondary to the viral infection (3,9,10). The gold standard for diagnosis is liver biopsy (11), but it is an invasive procedure with possible contraindications in case of hepatitis-induced coagulopathy.…”

“…The reference treatment consists of high-dose antiviral therapy with acyclovir (3,14,15). Norvell et al's literature review (2) reports a reduced death rate from 88% down to 51% when acyclovir is initiated, with a mean time from overt symptoms to treatment of 4.2 days.…”

Donor derived HSV hepatitis in a kidney transplant recipient leading to liver fibrosis and portal hypertension

“…HSV hepatitis occurring in solid organ transplant recipients has been reviewed by Pietrucha and colleagues, who reported a mortality of 100% without acyclovir therapy vs 43% with treatment in over 40 solid organ transplant recipients who developed HSV hepatitis . In transplant patients, HSV hepatitis usually arises from either reactivation of latent HSV or de novo primary HSV infection.…”

“…The development of HSV hepatitis has been reported in kidney, liver, pancreas, heart, and lung transplant recipients . Most commonly, this has occurred from either reactivation of latent HSV in the recipient or de novo primary infection.…”