Hepatitis in an Adult Caused by Herpes Simplex Virus Type I

Eron, Larry; Kosinski, Katharine; Hirsch, Martin S.

doi:10.1016/s0016-5085(76)80464-7

Cited by 42 publications

(8 citation statements)

References 13 publications

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“…The one observed in the two patients who survived (5,15) is characterized by dense inflammatory cell infiltrates in contact with necrotic foci; these infiltrates were found early in the course of the disease; this inflammatory pattern of HSV liver necrosis attests healing and adequately restrained HSV lesions (26). The other pattern, observed in our patient and in seven other fatal cases (6,8,9,14,16,17,21), is characterized by the absence or paucity of the inflammatory cell infiltrates in contact with necrotic foci. In these eight adults, the serum transaminases level was markedly higher than that reported in the two adults who recovered (5,15) and, as in neonates (25), non-inflammatory HSV liver necrosis was often extensive.…”

Section: Discussionsupporting

confidence: 56%

“…From our case and from the other nine cases reported in adults with detailed description of liver lesions (5,6,8,9,(14)(15)(16)(17)21), two patterns of HSV liver lesions can be distinguished. The one observed in the two patients who survived (5,15) is characterized by dense inflammatory cell infiltrates in contact with necrotic foci; these infiltrates were found early in the course of the disease; this inflammatory pattern of HSV liver necrosis attests healing and adequately restrained HSV lesions (26).…”

Section: Discussionmentioning

confidence: 57%

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Non‐inflammatory herpes simplex hepatitis in an adult with chronic neutropenia

Bernuau

Rueff

Clauvel

et al. 1981

Liver

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ABSTRACT— We report the case of a young woman with chronic neutropenia, in whom hepatitis, extensive herpetic eruption and herpes simplex viremia developed after genital herpetic ulceration. Although severe liver necrosis was present, the patient's death did not result from hepatic failure. No inflammatory cell infiltration was found circumscribing the multiple necrotic foci in the liver. This absence of inflammatory cell infiltration reflects the host's inability to normally restrain herpes simplex virus dissemination and, in this patient, might be the consequence of chronic neutropenia.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 57%

Non‐inflammatory herpes simplex hepatitis in an adult with chronic neutropenia

Bernuau

Rueff

Clauvel

et al. 1981

Liver

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“…HSV hepatitis was the cause of the acute failure of the first graft. The natural course of HSV hepatitis is usually rapidly fatal, and diagnosis is mostly made postmortem 13. Comparably, in this case high‐dose intravenous acyclovir was administered immediately after diagnosis but did not prevent acute liver failure due to extensive parenchymal necroses.…”

Section: Discussionmentioning

confidence: 84%

Recurrent herpes simplex virus hepatitis after liver retransplantation despite acyclovir therapy

et al. 2005

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Herpes virus hepatitis (HSV) represents a form of acute necrotizing hepatitis, which most frequently develops in immunocompromised patients. Therapeutic options include high-dose intravenous acyclovir and liver transplantation. We report the first case of recurrent HSV hepatitis after liver retransplantation, which occurred despite continuous administration of high-dose intravenous antiviral therapy. Because explant histology pointed to initial therapy response, we thought that the reason for recurrence might be due to acyclovir resistance. Most acyclovir resistance is caused by inactivating mutations in the herpes virus thymidine kinase gene. HSV infection was detected by histology and proofed by immunohistochemistry. PCR amplification of the herpes virus thymidine kinase gene was performed on histology specimens to demonstrate the course of viral infection in liver tissue. Genotypic resistance testing of the herpes virus was performed by sequencing the thymidine kinase amplicon. In serial biopsy, HSV-DNA sequences were only detectable when histology revealed herpes hepatitis. Whereas the primary explant exhibited the wild-type thymidine kinase gene, a biopsy of the second graft one month after retransplantation, which showed recurrent herpes virus hepatitis, had a single base insertion within a homopolymeric cytosine stretch. This mutation causes a frame shift leading to a premature stop codon and results in a known acyclovirresistant herpes strain. In conclusion, we believe that testing for acyclovir-resistant herpes strains should be considered in high-risk patients in whom viral clearance is not achieved serologically to prevent fatal recurrence of disease by using antiviral drugs such as inhibitors of HSV-DNA polymerase or viral helicase primase inhibitors. H erpes simplex virus (HSV) hepatitis is an infrequent form of viral hepatitis, which occurs mainly, although not exclusively, in immunosuppressed patients and children. [1][2][3][4] In a recent prospective multicenter study, the incidence was well below 1% (1/354) of all cases with acute liver failure and 2% (1/43) of all cases with virus-related acute liver failure. 5 HSV hepatitis occurs with a frequency of 2% in children after liver transplantation. 6 Therapeutic options for manifest HSV hepatitis are high-dose intravenous therapy with acyclovir and liver transplantation. 1,[7][8][9][10] According to a recent Dutch study, the prevalence of acyclovir-resistant herpes simplex virus strains is about 0.3% in immunocompetent patients in contrast to 7% in immunocompromised patients. 11 The following case report describes a 61-year-old man who received an orthotopic liver transplantation for alcoholic liver cirrhosis and who then developed HSV hepatitis in his graft. Despite immediate highdose antiviral therapy, he developed acute liver failure, was retransplanted, and then developed recurrent and fatal HSV hepatitis in his second graft despite continuous antiviral therapy. Case ReportA 61-year-old male caucasian patient was admitted to our university hosp...

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“…As early as 1976 Eron et al 38 suggested that a search should be made for visible vesicular lesions (mouth, pharynx, esophagus, skin, genital tract) in the diagnosis of HSV hepatitis; "these should be smeared for giant cells and intranuclear inclusions, as well as appropriately cultured for virus." Results of Tzanck smears or fluorescent antibody testing of air-dried smears or touch preparations of the lesions are usually available in a matter of hours.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

“…Cutaneous and cervical lesions were identified on post- mortem examination of case 1. 25 In the non-pregnant group, m-c involvement was identified in 21 (72%) patients of whom, 4 [36][37][38]50 were only discovered at post-mortem (see Table 4). The vagina and cervix were not examined in case 2, but the patient had a recent past history of genital herpes and presented with dysuria.…”

Section: Are M-c Lesions Present In Patients With Hs Hepatitis?mentioning

confidence: 99%

Herpes Simplex Hepatitis in Adults

Sharma

Mosunjac²

2004

Journal of Clinical Gastroenterology

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Herpes simplex hepatitis is a treatable cause of acute hepatitis with a high mortality (41% to 79%). We present 4 adult patients who died of herpes simplex hepatitis and review another 70 patients (including pregnant women) from the literature to illustrate that herpes simplex hepatitis was only considered in the differential diagnosis in 26% to 33% of patients even though muco-cutaneous involvement was present in at least 70% of these patients. The presence of muco-cutaneous lesions in a patient with clinical symptoms and biochemical findings of acute hepatitis should raise the suspicion of herpes simplex hepatitis. Prompt treatment with acyclovir can be initiated within hours of admission in an attempt to prevent further hepatocellular damage in this potentially life-threatening infection.

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Hepatitis in an Adult Caused by Herpes Simplex Virus Type I

Cited by 42 publications

References 13 publications

Non‐inflammatory herpes simplex hepatitis in an adult with chronic neutropenia

Non‐inflammatory herpes simplex hepatitis in an adult with chronic neutropenia

Recurrent herpes simplex virus hepatitis after liver retransplantation despite acyclovir therapy

Herpes Simplex Hepatitis in Adults

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