Herpes hepatitis as a complication of total abdominal hysterectomy; an unusual complication of abdominal instrumentation

Abstract

Key Clinical MessageHerpes simplex virus hepatitis is a rare but potentially fatal disease without early intervention. Impaired immunity is a major predisposing risk factor but infection in immunocompetent individuals is not unheard of. Diagnosis is complicated by its rarity and nonspecific signs and symptoms on presentation. Identification by liver biopsy is often limited due to concurrent coagulopathy. Early and aggressive treatment is centered on antiviral therapy with acyclovir. We present a case of herpes hepatitis in an immunocompetent woman following abdominal instrumentation.

Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis

“…Interestingly, the development of HSV hepatitis following a surgical procedure has been described. [ 21 ] Yokoi et al reviewed 14 cases with HSV ALF after a surgical procedure; of these cases, 2 were gynecological, where the common presentation was fever, with a median postoperative time of 4.5 days. [ 22 ]…”

“…Interestingly, the development of HSV hepatitis following a surgical procedure has been described. [21] Yokoi et al reviewed 14 cases with HSV ALF after a surgical procedure; of these cases, 2 were gynecological, where the common presentation was fever, with a median postoperative time of 4.5 days. [22] Drug-induced liver injury (DILI), particularly idiosyncratic hepatotoxic reactions, could resemble symptoms and course of an acute viral hepatitis.…”

A Rare Case of Herpes Simplex Virus-2 Hepatitis with Negative Serology

“…Potential mechanisms of herpes induced hepatitis include (i) a large HSV inoculum overwhelming the immune system on initial encounter; (ii) dissemination of mucosal herpetic lesions within a suppressed immune system; (iii) reactivation of a latent HSV reactivation or reinfection with a different new strain of HSV 4 (Hepatovirulent HSV) [4]. Disseminated HSV-2 infection has been defined by presence any of the following criteria, (a) positive HSV-2 IgM antibody test results, (b) HSV-2 DNA detected by polymerase chain reaction (PCR) assay of the peripheral blood mononuclear cells (PBSCs), or (c) involvement of two or more noncontiguous sites concurrently [5].…”