Fatal fulminant herpes simplex hepatitis following surgery in an adult

Yokoi, Yoshihiro; Kaneko, Takeshi; Sawayanagi, Tomoki; Takano, Yasuo; Watahiki, Yoichi

doi:10.12998/wjcc.v6.i2.11

Cited by 8 publications

(9 citation statements)

References 40 publications

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“…By day eight, her herpes labialis became apparent, resulting in appropriate empiric treatment with valacyclovir 1g orally every eight hours and confirmation with positive HSV-1 IgM and HSV-1 PCR. Similar to our patient's onset of symptoms, Yokoi et al demonstrated that with HSV hepatitis, high fever is the universal first sign with median onset by day 4.5, followed by gastrointestinal symptoms on day seven and liver dysfunction by day 8.5 [3]. Mucocutaneous lesions such as herpes labialis are a classic sign commonly seen with HSV-1 reactivation yet its absence does not rule out HSV as cause for hepatitis due to it being reported in less than 50% of HSV hepatitis patients [5,6].…”

Section: Discussionsupporting

confidence: 86%

“…HSV hepatitis as a post-surgical complication in a healthy immunocompetent patient, as in our case, is considered exceedingly rare [3]. In a 15-case review by Yokoi et al, various types of surgeries were involved, however, no specific procedure has been demonstrated to suggest any relationship to HSV hepatitis [3]. The pathogenesis of HSV hepatitis is unclear at the moment but there is concern that surgical manipulation may cause excessive inflammation resulting in immune modulation.…”

Section: Discussionmentioning

confidence: 67%

“…The pathogenesis of HSV hepatitis is unclear at the moment but there is concern that surgical manipulation may cause excessive inflammation resulting in immune modulation. This source of physiological stress and inflammation may lend itself to a unique post-surgical course characterized by reactivation of previously dormant HSV-1 infection, HSV-1 viremia, and subsequent acute liver injury or failure secondary to HSV hepatitis [3].…”

Section: Discussionmentioning

confidence: 99%

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

Ngo

Mdluli

et al. 2020

Cureus

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We present a rare case of a healthy, non-pregnant, middle-aged and immunocompetent woman who underwent laparoscopic cholecystectomy for acute cholecystitis with a post-operative course complicated by herpes simplex virus type 1 (HSV-1) hepatitis secondary to post-surgical inflammation. Her initial post-operative course was complicated by intermittent fevers, leukocytosis, jaundice, elevated transaminases, and right upper quadrant abdominal pain, and she was subsequently placed on broad-spectrum antibiotics with no improvement. During her hospital course, the patient developed herpes labialis, and HSV-1 hepatitis was confirmed by serology and HSV-1 polymerase chain reaction (PCR), in lieu of a liver biopsy. After this was discovered, the patient was placed on valacyclovir and had a successful response. The importance of this case is to emphasize the possibility of herpes simplex virus (HSV) hepatitis as a post-operative complication and the benefit of early empiric antiviral treatment.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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

Ngo

Mdluli

et al. 2020

Cureus

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“…[ 21 ] Yokoi et al reviewed 14 cases with HSV ALF after a surgical procedure; of these cases, 2 were gynecological, where the common presentation was fever, with a median postoperative time of 4.5 days. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis

et al. 2021

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Introduction: Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported. Patient concerns: A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function. Diagnosis: ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood. Interventions: Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated. Outcomes: After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation. Conclusions: ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.

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“…Although screening for common forms of viral hepatitis, including hepatitis A to E is nearly universal, testing for viruses less frequently considered hepatropic may not always be complete[ 10 , 11 ]. For example, some cases of herpes virus-associated fulminant hepatitis were only confirmed by postmortem liver biopsy[ 12 ]. VZV is a hepatropic virus that belongs to the family of herpes viruses, and is the cause of chickenpox, a highly contagious but generally mild disease in childhood, which could be more severe in adults.…”

Section: Discussionmentioning

confidence: 99%

Successful rescue of acute liver failure and hemophagocytic lymphohistiocytosis following varicella infection: A case report and review of literature

Zhang

Guo

Zhu

et al. 2018

WJCC

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Herein we report a case of acute liver failure (ALF) and hemophagocytic lymphohistiocytosis (HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient’s condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction (PCR) amplifications of varicella-zoster virus (VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient’s symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.

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Fatal fulminant herpes simplex hepatitis following surgery in an adult

Cited by 8 publications

References 40 publications

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

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

Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis

Successful rescue of acute liver failure and hemophagocytic lymphohistiocytosis following varicella infection: A case report and review of literature

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