Herpes Simplex Type 2 Causing Fulminant Hepatic Failure

Fahy, Ruairi J.; Crouser, E.D.; Pacht, Eric R.

doi:10.1097/00007611-200012000-00015

Cited by 13 publications

(15 citation statements)

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“…Immunocompetent individuals, including pregnant patients [17] and those with no other identified immunosuppressive condition [5, 18–20], may also present with disseminated disease. In addition, up to 25% of patients with primary genital HSV have PCR-detectable virus in their peripheral blood [21].…”

Section: Introductionmentioning

confidence: 99%

Clinical Correlates of Herpes Simplex Virus Viremia among Hospitalized Adults

Berrington¹,

Jerome

Cook

et al. 2009

CLIN INFECT DIS

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Background The quantification of herpes simplex virus (HSV) DNA from the peripheral blood is often used to evaluate patients suspected of having disseminated HSV infection. Few studies have examined the clinical correlates of HSV viremia among adults. Methods We conducted a retrospective analysis of blood samples sent to a reference molecular virology diagnostic facility at a university hospital for quantification of HSV DNA between October 2001 and June 2006. Medical records of patients with detectable HSV DNA were reviewed to abstract relevant clinical characteristics. Results HSV DNA was detected in 37 (4.0%) of 951 samples from 29 individual patients. 19 (65.5%) were >16 years of age, and detailed medical records were available for review from 13 (68.4%) of 19 adults patients. Of the 10 patients whose HSV infection was typed, 6 (60%) had HSV-2, 3 (30%) had HSV-1, and one had evidence of both HSV-1 and HSV-2 infection. All viremic patients were treated with antiviral medications. The most common clinical findings were hepatitis (62%), fever (54%), CNS alterations (46%), skin lesions (38%), abdominal pain (31%), and sepsis (31%). Respiratory failure (23%) was uncommon. Patients with HSV viremia were observed to have a high mortality rate (6 of 10 immunocompromised and 1 of 3 immunocompetent individuals). Conclusions HSV viremia may be associated with a variety of morbid signs and symptoms in hospitalized immunocompetent and immunocompromised adults, and is associated with high rates of mortality, though causality can only be determined by additional studies.

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Section: Introductionmentioning

confidence: 99%

Clinical Correlates of Herpes Simplex Virus Viremia among Hospitalized Adults

Berrington¹,

Jerome

Cook

et al. 2009

CLIN INFECT DIS

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“…Most of the case studies have demonstrated marked elevations of transaminases with AST > ALT (up to 1000-fold). Leukopenia is also a common finding in HSV hepatitis [3][4][5][6][7]. In our case, the leukopenia and the thrombopenia are likely due to myelosuppression caused by the chemotherapy with docetaxel and cisplatin.…”

Section: Discussionmentioning

confidence: 68%

“…Biopsy including immunohistochemical staining is the gold standard test in this situation [7,12]. The histology is characterized by areas of cellular necrosis with little inflammation and hepatocytes with either eosinophilic inclusion bodies or the more characteristic pattern of homogeneous pale chromatin [4][5][6]. However, as in our case, liver biopsy is frequently not possible because of severe coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Fatal Herpes Simplex Virus Hepatitis in a Patient with Esophageal Cancer under Radiochemotherapy

Grimm

Padberg²,

Ruhstaller³

et al. 2008

Oncol Res Treat

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Background: Herpes simplex virus (HSV) infections are frequent. However, HSV hepatitis is rare and may lead to a life-threatening condition. Case Report: A 68-year-old patient with a locally advanced and inoperable esophageal carcinoma was treated with induction chemotherapy and combined chemoradiation. After a total of 9 weeks of treatment, he developed fulminant liver failure of unknown origin and died a few days later. Surprisingly, the post mortem examination revealed an HSV infection of the esophagus and an HSV-associated necrotisizing hepatitis. Conclusion: In this immunocompromised patient, we postulate an HSV-associated esophagitis that led to viremia and fulminant hepatitis. Especially in immunocompromised hosts, HSV hepatitis should be considered in the differential diagnosis in patients with anicteric hepatitis and marked elevation of transaminases. A liver biopsy is the quickest and most definitive diagnostic tool to diagnose HSV hepatitis. If this is not possible because of severe coagulopathy, polymerase chain reaction for HSV DNA should be performed. Awaiting diagnosis, a prompt empirical treatment with acyclovir has to be discussed in case of a characteristic biochemical profile.

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“…This finding is similar to hepatitis due to herpes simplex virus (HSV), in which bilirubin levels are typically only slightly increased from normal [10]. A diagnosis of HSV-induced hepatitis is difficult because clinical suspicion is often low, especially in immunocompetent patients.…”

Section: Discussionmentioning

confidence: 82%