Successful Acyclovir Treatment of Herpes Simplex Type 2 Hepatitis in a Patient with Systemic Lupus Erythematosus: A Case Report and Meta Analysis

Chung, Andrew B.; Fas, Norberto

doi:10.1016/s0002-9629(15)40453-7

Cited by 11 publications

(14 citation statements)

References 16 publications

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“…The natural course without specific therapy of HSV hepatitis is sobering with mortality rates up to 90%, making HSV hepatitis the most fatal complication followed by HSV encephalitis with mortality rates of 10-30% (6).…”

Section: Definition and Etiology Of Acute Liver Failurementioning

confidence: 99%

Herpes simplex virus sepsis and acute liver failure

Riediger

Sauer

Matevossian

et al. 2009

Clinical Transplantation

109

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Acute liver failure is a life threatening disease mostly triggered by drug-induced or toxic liver damage or viral hepatitis. Herpes Simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures. The importance of HSV-induced acute liver failure is based on its extremely severe clinical course with lethality rates of almost 75%. HSV hepatitis is just one of several clinical manifestations of HSV sepsis leading more frequently to encephalitis, pneumonia and esophagitis. Local herpes infection or recurrence of dermal lesions (herpes labialis, herpes genitalis), however, is common and account for the high prevalence of HSV-1 or HSV-2 infection in adults. Another rare entity is visual dissemination, which mostly affects immunocompromised patients. Compromised cellular immunity is a major risk factor for HSV sepsis because of either primary infection or reactivation of occult chronic HSV infection. Delayed diagnosis without antiviral therapy significantly contributes to the unfavorable outcome. Typically, anicteric hepatitis is seen in patients with HSV hepatitis. Because of its low incidence, however, and the lack of dermal manifestations, HSV hepatitis is rarely considered in the context of acute liver failure. In addition, diagnostic tests might not always be available. Therefore, it is a generally accepted consensus to begin antiviral therapy pre-emptively with acyclovir in cases of acute liver failure of unknown origin, in which high urgency (HU) liver transplantation remains the only therapeutical option. Even in the case of early specific therapy, sepsis may prevail and the indication for HU transplantation must be evaluated carefully. The outcome after liver transplantation for HSV-induced liver failure with reported survival rates of more than 40% is good. Because of the risk of recurrence, lifelong prophylaxis with acyclovir is recommended.

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Section: Definition and Etiology Of Acute Liver Failurementioning

confidence: 99%

Herpes simplex virus sepsis and acute liver failure

Riediger

Sauer

Matevossian

et al. 2009

Clinical Transplantation

109

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“…5 Prognostic markers on presentation and during the course of disease would be of great use to clinicians in determining the likelihood of clinical progression, need for liver transplantation (LT), or spontaneous recovery. 6 Given previous data and knowledge on HSV hepatitis has originated from multiple case reports, this article represents a comprehensive analysis of all the documented adult cases of HSV hepatitis from our center and in the literature to determine patient characteristics and prognostic factors associated with important outcomes.…”

mentioning

confidence: 99%

Herpes simplex virus hepatitis: An analysis of the published literature and institutional cases

Norvell¹,

Blei²,

Jovanovic³

et al. 2007

Liver Transpl

237

318

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Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovirtreated patients as compared to 88% in the untreated subjects (P ϭ 0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age Ͼ40 yr, immunocompromised state, ALT Ͼ5,000 U/L, platelet count Ͻ75 ϫ 10 3 /L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.

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“…HSV hepatitis should be considered an infectious disease emergency. Left untreated, HSV hepatitis has a mortality rate of 86% 7. With acyclovir therapy, the mortality rate dropped to 33% in one study,2 and empiric therapy should be considered if HSV hepatitis is suspected 6…”

Section: Discussionmentioning

confidence: 99%