Fulminant herpes simplex viral hepatitis: ultrasound and CT imaging appearance and a review of the imaging literature

Tripuraneni, Vinay; Patel, Keyur; Brennan, Todd V.; Ho, Lisa M.

doi:10.1016/j.clinimag.2013.11.015

“…Ante-mortem diagnostic tools include the detection and quantification [6] of blood viral HSV DNA, liver biopsy and serological testing for HSV [7] . In rare cases, some lesions can be seen on computed tomography imaging [8] . Treatment includes aciclovir, which is effective in 51% of cases [4] .…”

Section: Discussionmentioning

confidence: 99%

Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report

Inthasot

¹

,

Goushchi

²

,

Lazzaroni

³

et al. 2018

European Journal of Case Reports in Internal Medicine

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Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive Escherichia coli. After empirical treatment with piperacillin-tazobactam was initiated, the patient’s condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.LEARNING POINTSHerpes simplex virus hepatitis should be considered in patients with acute liver failure.This condition can occur even in immunocompetent individuals.Empirical treatment with aciclovir should be initiated in case of clinical suspicion.

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“…Interestingly, our case of acute HSV hepatitis presented significantly different imaging findings from those described in previous reports. Characteristic CT imaging features associated with HSV hepatitis include the presence of diffuse hypodense 1 to 3 mm lesions, often confluent, with associated hepatomegaly [13][14][15]. In contrast to this, our patient's imaging more closely resembled hepatic pyogenic abscesses, typically characterized by larger hypodense lesions or, as seen in our patient, small clustered hypodense lesions with rim enhancement [16].…”

Section: Discussionmentioning

confidence: 64%

Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

Mehta

¹

,

Down

²

,

Salama

³

et al. 2016

American Journal of Gastroenterology

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Herpes simplex virus (HSV) hepatitis represents a rare complication of HSV infection, which can progress to acute liver failure and, in some cases, death. We describe an immunocompetent 67-year-old male who presented with one week of fever and abdominal pain. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen showed multiple bilobar hepatic lesions, some with rim enhancement, compatible with liver abscesses. Subsequent liver biopsy, however, revealed hepatocellular necrosis, HSV-type intranuclear inclusions, and immunostaining positive for herpes virus type 2 (HSV-2). Though initially treated with broad-spectrum antibiotics, following histologic diagnosis of HSV hepatitis, the patient was transitioned to intravenous acyclovir for four weeks and he achieved full clinical recovery. Given its high mortality and nonspecific presentation, one should consider HSV hepatitis in all patients with acute hepatitis with multifocal hepatic lesions of unknown etiology. Of special note, this is only the second reported case of HSV liver lesions mimicking pyogenic abscesses on CT and MRI.

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“…Characteristic CT imaging features associated with HSV hepatitis include the presence of diffuse hypodense 1 to 3 mm lesions, often confluent, with associated hepatomegaly [13–15]. In contrast to this, our patient's imaging more closely resembled hepatic pyogenic abscesses, typically characterized by larger hypodense lesions or, as seen in our patient, small clustered hypodense lesions with rim enhancement [16].…”

Section: Discussionmentioning

confidence: 73%

Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

Down

¹

,

Mehta

²

,

Salama

³

et al. 2016

Case Reports in Hepatology

View full text Add to dashboard Cite

Herpes simplex virus (HSV) hepatitis represents a rare complication of HSV infection, which can progress to acute liver failure and, in some cases, death. We describe an immunocompetent 67-year-old male who presented with one week of fever and abdominal pain. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen showed multiple bilobar hepatic lesions, some with rim enhancement, compatible with liver abscesses. Subsequent liver biopsy, however, revealed hepatocellular necrosis, HSV-type intranuclear inclusions, and immunostaining positive for herpes virus type 2 (HSV-2). Though initially treated with broad-spectrum antibiotics, following histologic diagnosis of HSV hepatitis, the patient was transitioned to intravenous acyclovir for four weeks and he achieved full clinical recovery. Given its high mortality and nonspecific presentation, one should consider HSV hepatitis in all patients with acute hepatitis with multifocal hepatic lesions of unknown etiology. Of special note, this is only the second reported case of HSV liver lesions mimicking pyogenic abscesses on CT and MRI.

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Fulminant herpes simplex viral hepatitis: ultrasound and CT imaging appearance and a review of the imaging literature

Cited by 9 publications

References 18 publications

Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report

Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report

Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

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