Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

Abstract

Background:Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon.Methods:We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease.Results:A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery.Conclusions:Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease.

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

“…Although HSV colitis is rare, it can mimic the endoscopic features of acute GVHD, cytomegalovirus or other forms of colitis. Endoscopic findings in HSV colitis might include mucosal oedema, erythema and well-demarcated ulcers of variable size and depth, with or without purulent exudate, that are often separated by normal-appearing mucosa 84 . HSV infection is more likely to be detected by sampling the edge of an ulcer, as HSV infects squamous epithelial cells 83 .…”

Multi-organ involvement secondary to varicella zoster virus, herpes simplex virus and cytomegalovirus in an immunocompromised patient

“…Her CT abdomen/pelvis at our facility indicated bowel thickening. HSV can induce colonic ulcerations as well as diarrhoea 1 5. However, the signs of HSV colitis are non-specific and the role of serology testing is not helpful, as this is a commonly encountered virus 6.…”

“…Herpes simplex virus (HSV) 1 and 2 infections are common, with an estimated seroprevalence of 50% and 15%, respectively, in the general US population 1. HSV can be reactivated throughout life but usually presents as a mild disease, such as mucocutaneous involvement in immunocompetent patients.…”

“…The use of certain immunomodulatory agents can act as a catalyst for HSV, VZV or CMV reactivation and promote systemic infection, including organ involvement 1 3 5 6. Current literature remains sparse but does provide individual case reports involving one virus.…”

Herpes Simplex Virus Colitis in a Patient with Newly Diagnosed Crohn’s Disease

“…A higher index of suspicion will lead to earlier diagnosis and management, which can significantly alter the clinical course and ultimately improve patient outcomes [ 12 ]. In such cases, the physical examination can be helpful as it was in our case—there was evidence of vesicular lesions indicating mucocutaneous manifestation of active HSV infection [ 7 ]. However, the most essential component in the diagnosis of HSV colitis is immunohistochemistry.…”