Fulminant hepatitis from herpes simplex virus type 2 in an immunocompetent adult

Abstract

Herpes simplex virus (HSV) is regarded as a common viral pathogen that produces a wide variety of diseases. After a primary infection, which usually occurs during childhood and may or may not be clinically evident, the virus establishes a latent infection in the local sensory ganglia and can reactivate throughout the life of the individual. Fulminant hepatic failure (FHF) due to HSV infection is a clinical condition well known in pediatric, immunocompromised, and pregnant patients. It is rare in immunocompetent hosts. We report the case of a 51-year-old man with no significant past medical history who developed FHF with disseminated intravascular coagulopathy and septic shock secondary to HSV infection. The initial diagnosis was made through a frozen section of a needle liver biopsy and the presence of HSV was confirmed in the permanent section with immunohistochemistry. HSV was grown in cell culture from liver tissue obtained through an autopsy.

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

“…Although subsequent cases of pregnancy‐related HSV hepatitis have been reported , overall, HSV hepatitis occurs less frequently in immunocompetent individuals when compared with individuals with an underlying chronic disease or an immunocompromising associated risk factor, including steroid use , asthma , psoriatic arthritis , and systemic lupus erythematosus . HSV hepatitis has also been reported in individuals with multiple myeloma, hairy cell leukemia, and Hodgkin's lymphoma , in addition to HSV hepatitis occurring in a patient after thymoma removal .…”

Herpes Simplex Virus Hepatitis in an Immunocompetent Adult: A Fatal Outcome due to Liver Failure

“…Renal failure is not uncommon in these patients [5, 11–14], and it has been shown to occur in up to 65% of patients with HSV-related ALF [3]. Disseminated intravascular coagulopathy is frequently reported [5, 8, 9, 15, 16], and encephalopathy is a late sign of the disease. Ninety percent of patients with HSV hepatitis have a characteristic liver profile, known as “anicteric hepatitis” [6, 9, 17, 18].…”

“…Ninety percent of patients with HSV hepatitis have a characteristic liver profile, known as “anicteric hepatitis” [6, 9, 17, 18]. Anicteric hepatitis refers to a liver profile showing a significant increase in transaminases (100–1000 fold) with a relatively normal or low bilirubin [1, 3, 6, 9, 16]. There may be a marked elevation of AST greater than ALT [6].…”

Acute liver failure in the setting of herpes simplex virus and coexistent acute fatty liver of pregnancy

“…Described as nuclei with large eosinophilic ground glass-like inclusions surrounded by a clear halo, Cowdry Type A inclusions are pathognomonic for HSV hepatitis. However, margination of the chromatin, multinucleation and nuclear molding are more commonly seen [9][10][11] . Immunohistochemical staining can confirm the diagnosis of HSV.…”