Herpes Simplex Virus Hepatitis: A Brief Review of an Oft-overlooked Pathology

Abstract

Herpes simplex virus (HSV) is a rarely reported cause of viral hepatitis. Aggressive in nature, most cases of HSV hepatitis rapidly progress to fulminant hepatic failure. Present day, its pathogenesis is yet to be elucidated, but its complications and associated high mortality rate are clear. Clinically, its symptoms mimic those of other causes of acute hepatic failure thus making the diagnosis of HSV hepatitis a precarious task. Although treatment in the form of acyclovir is readily available, most cases have a poor prognosis due to late initiation of therapy. This makes the early identification of HSV essential in improving outcomes and potentially preventing mortality.

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

“…HSV accounts for 0.8% of ALF cases and 1% to 2% of viral hepatitis cases; however, its mortality rate remains as high as 90% in some reports. [ 10 ] It has been mainly documented in immunosuppressed patients, pregnant women, and neonates; however, there are reports of HSV in previously healthy adults. [ 9 , 12 ] In the largest review of HSV hepatitis, 24% of the 137 patients with HSV were considered immunocompetent.…”

“…This is not a universal finding, and less than half of the reported cases present with mucocutaneous lesions suggestive of HSV. [ 10 ]…”

“…Elevations greater than 10 times the upper limit of baseline values are suggestive of ischemic, toxic, or viral liver injury. [ 10 ] Moreover, 90% of patients with HSV hepatitis have a 100 to 1000-fold increase in transaminases, [ 8 ] particularly with an “anicteric pattern,” indicating the considerable elevation in transaminases, with AST values greater than ALT values and normal or relatively low bilirubin. [ 19 ] Our patient presented with more than a 100-fold increase in transaminases, with AST values greater than ALT values and an anicteric pattern.…”

“…ALF has been described mostly in neonates, immunosuppressed patients, [ 8 ] and pregnant women, [ 9 ] with poor outcomes. [ 10 ]…”

Severe Acute Hepatitis in a COVID‐19 patient: A Case Report

“…Clinically, it is indistinguishable from other causes of acute viral hepatitis, and it is frequently associated with a poor prognosis due to delayed diagnosis and treatment. 11 …”