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

Abstract

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.

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

“…A liver biopsy would show hepatic necrosis, HSV, immunoreactivity to HSV, and intranuclear inclusions . If a liver biopsy is not safe for the patient due to coagulopathy, then HSV PCR in real time would be another test to help diagnose herpes hepatitis . The study done by Beersma et al showed improved early diagnosis and management of herpes hepatitis.…”

“…4,7 If a liver biopsy is not safe for the patient due to coagulopathy, then HSV PCR in real time would be another test to help diagnose herpes hepatitis. 3,8,9 The study done by Beersma et al 10 showed improved early diagnosis and management of herpes hepatitis. The study further showed liver kinetics and HSV DNA load in serum can lead to diagnosis.…”

Hepatitis caused by herpes viruses: A review

“…(b) Immunostaining for HSV‐2 highlights the infected cells. Reprinted with permission from Down et al .’s study …”

“…The utility of serology including immunoglobulin M and G antibodies is limited by false positive and false negative results. An HSV DNA polymerase chain reaction using blood samples is rapid to perform and has a higher sensitivity and specificity than HSV antibodies …”

Herpes Simplex Virus Type 1 Hepatitis in an Immunocompetent Female After Laparoscopic Cholecystectomy

“…Herpes simplex virus type 1 (HSV-1) is a highly prevalent mucocutaneous infection worldwide, however herpes simplex virus (HSV) hepatitis is a rare complication with high morbidity and mortality, accounting for 0.8% of all acute liver failure cases [1,2]. Many cases of HSV hepatitis have been previously reported in the literature in pregnant women and individuals who are immunosuppressed for treatment of various medical conditions such as malignancies.…”