Septic shock complicated by disseminated herpes simplex virus-1 infection: a case report

Abstract

Background Herpes virus remains dormant in human cells and could reactivate under immunosuppressed conditions, such as prolonged critical illnesses. The phenomenon of viral replication during intensive care is well known, even in patients without a history of immunosuppression, but it usually does not have a clinical impact. Systemic reactivation leads to viral DNA in blood. It remains unclear whether this replication is a marker of morbimortality or a true pathogenic process. Therefore, it is unclear what medical treatment is most appropriate for simple replication. In organ damage suspected to be induced by herpes virus, there is no consensus on the most appropriate treatment duration. Here, we report a rarely described case of multiorgan failure implicating herpes simplex virus and discuss its treatment. Case report A 53-year-old Caucasian immunosuppressed woman was admitted to the intensive care unit for septic shock. She presented pneumonia due to Klebsiella pneumoniae. Two weeks after admission, she showed multiorgan failure with acute respiratory distress syndrome and circulation failure. She had digestive and cutaneous lesions typical of herpes simplex virus 1. Blood and respiratory polymerase chain reaction was strongly herpes simplex virus-1 positive. No other bacteria, fungi, or viruses were found. The evolution was rapidly favorable after the initiation of antiviral treatment. Treatment was stopped after 3 weeks of well-conducted antiviral therapy. Curative-dose treatment was interrupted despite continuous strongly positive blood polymerase chain reaction results. In this context, prophylactic treatment was continued. Conclusion We report an exceptional presentation of multiorgan failure in the intensive care unit due to herpes simplex virus-1. The diagnosis was made based on typical herpes simplex virus-1 visceral lesions and the absence of other responsible microorganisms. Intense viral replication is a key diagnostic element. There is no consensus regarding the most appropriate treatment duration, but such decisions should not be based on blood polymerase chain reaction.

Septic shock due to candida and disseminated herpes simplex virus-1 (HSV1) after elective spinal surgery in an immunocompromised patient with chronic HSV1 infection

“…Mortality is reported to be as high as 40% with disseminated candidiasis in immunocompromised individuals. Risk factors for disseminated candidiasis include malignancy, immunosuppressive factors such as corticosteroids, diabetes, infection and poor lifestyle habits such as chronic tobacco, alcohol and drug abuse [ 3 ]. As mentioned, our patient had completed multiple courses of prednisone therapy over the 3-month period preceding her elective surgery and received additional glucocorticoids postoperatively.…”

Exploring the Pathophysiology of Long COVID: The Central Role of Low-Grade Inflammation and Multisystem Involvement

“…However, assessing the impact of HHV-6 on systemic low-grade inflammation processes may still be premature. Cases of life-threatening systemic hyperinflammation (viral sepsis) linked to disseminated herpes simplex virus 1 and 2 (HSV-1, HSV-2) infections have been documented [ 194 , 195 ]. HSVs may also play roles in systemic and local para-inflammatory processes, including neuroinflammation and neurodegeneration [ 196 ].…”

Potential of Interleukin (IL)-12 Group as Antivirals: Severe Viral Disease Prevention and Management

“…Eventually, the infected person may undergo prolonged inflammation due to perpetual uncontrollable virus replication. This condition further results in chronic viral diseases and system failure [ 47 ]. Of note, in addition to its anti-inflammatory actions, IL-35 also induces antiviral activities via the synthesis of interferons which in turn undermines virus infections through several virucidal pathways.…”