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

Abstract

Herpes simplex virus-2 (HSV2) hepatitis represents a rare but serious complication of HSV2 infection that can progress to acute liver failure (ALF). We describe a case of a pregnant teenager who presented with four days of fever, headache, malaise, nausea, and vomiting. She was initially misdiagnosed with sepsis of unclear source and treated with broad-spectrum antibiotics. Empiric acyclovir was started one week into her hospitalization despite negative serologies while awaiting HSV2 PCR leading to complete resolution of symptoms. Given its high mortality and nonspecific presentation, clinicians should consider HSV hepatitis in all patients with acute hepatitis especially in high-risk population.

A Surprising Cause of Liver Abscesses in a Post-Chemotherapy Patient: Herpes Simplex Virus

“…Although the pathogenesis of HSV hepatitis is not well established, potential mechanisms of acute liver failure include: (i) a large HSV inoculum overwhelming the immune system; (ii) dissemination of mucosal herpetic lesions in the setting of a suppressed immune system; (iii) acute HSV infection, superimposed on a latent HSV reactivation; or (iv) re-infection with a proposed strain of hepatovirulent HSV [ 6 ].…”

Prolonged fever and hyperferritinaemia: a puzzling diagnosis of neonatal herpes simplex virus infection during COVID-19 pandemic

“…The negative HSV serology was explained by the fact that it takes about 2–3 weeks for antibodies to develop against HSV, resulting in serology being negative at that period. 13 …”

“…The negative HSV serology was explained by the fact that it takes about 2-3 weeks for antibodies to develop against HSV, resulting in serology being negative at that period. 13 Elevated ferritin level has a number of causes, including neonatal HLH. Although the specific mechanism remains unknown, disseminated HSV infection has been identified as a trigger of neonatal HLH.…”