Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report

Abstract

Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive Escherichia coli. After empirical treatment with piperacillin-tazobactam was initiated, the patient’s condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.LEARNING POINTSHerpes simplex virus hepatitis should be considered in patients with acute liver failure.This condition can occur even in immunocompetent individuals.Empirical treatment with aciclovir should be initiated in case of clinical suspicion.

Herpes simplex virus hepatitis in a renal transplant recipient seronegative pre-transplant

“…There was mild portal inflammation without significant interface activity. Necrotic areas contained necrotic hepatocytes and minimal inflammation similar to previous reports (13,14); rare cells showed features of viral cytopathic effects, including glassy nuclei and marginated chromatin. Multinucleated cells were not identified.…”

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

“…There have been many reports of HSV pneumonia [ 3 ], and some cases of fulminant hepatitis [ 4 ] and sepsis [ 5 ] implicate HSV in immunocompetent and immunosuppressed patients. The present case is a rare description of HSV-1-induced septic shock causing multiorgan failure.…”

A case report of disseminated herpes simplex hepatitis masquerading as spinal headache

“…Skin manifestations are present in less than one-half of reported HSV hepatitis cases [2]. HSV is responsible for less than <2% of the viral causes of fulminant hepatitis and less then <1% of all causes of acute liver failure [3]. Clues to the possible diagnosis include the triad of fever, transaminitis, leukopenia, and low bilirubin levels [4].…”