HSV-induced hepatitis in pregnancy - A rare case report

Abstract

Hepatitis is mostly occurred by alcohol, drugs, or virus. Herpes simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures, but it is a fatal complication. Pregnant women are more vulnerable as the immunological changes during pregnancy suppress T-cell-mediated immunity promoting disseminated infection. Although HSV-associated hepatic failure carries a high-mortality risk, early intervention with acyclovir may prove to be life-saving. Here in, we report a case of 22-year-old female 8 weeks primigravida admitted with complaints of yellowish discoloration of eyes and urine and was provisionally diagnosed to have acute severe hepatitis with no hepatic encephalopathy or liver failure. Immunoglobulin M HSV test was positive, suggestive of HSV-induced hepatitis. Due to severe hepatic failure, living donor liver transplantation (left lobe with middle hepatic vein) was performed. She was treated with antivirals, immunosuppressants, and other conservative treatments. After few days her general condition was good, and laboratory investigations were stable. She was shifted out from intensive care unit. At the time of discharge, she was comfortable, vitals stable and wound was healthy. It should be considered in the differential diagnosis of any case of severe hepatitis with concomitant fever, abdominal pain, and elevated values of liver function tests with or without jaundice. The administration of intravenous acyclovir is inexpensive, without drug interactions, and safe even during pregnancy. Clinicians should be aware of HSV-induced hepatitis in immunocompromised patients and its risk factors.