Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis

Abstract

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Fatal outcome of herpes simplex virus type 1-induced necrotic hepatitis in a neonate

“…Comparable to our findings, several studies have demonstrated that generalized HSV infections can present with the major symptom of liver failure [1,8,9,15]. The extended histological investigations in our case demonstrate the irreversible damage of this organ.…”

“…Antiviral treatment must be introduced before an irreversible damage of liver tissue is present [1]. In the reported neonate, aciclovir was not given because all diagnostic measures failed to identify the causative agent.…”

Demographics and outcomes of severe herpes simplex virus hepatitis: A registry-based study

“…It is likely that most of the paediatric cases were linked to a vertical transmission from mother to newborn, as described earlier, even in cases of unrecognised maternal HSV infection [9][10][11][12]. The database did not allow the assessment of the co-morbidity profile at the time of listing.…”

Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 1: Herpes simplex virus infections

“…The point in time, at which treatment is started, is crucial for prognosis especially in case of disseminated infection. Thus, antiviral treatment must be introduced before an irreversible damage in particular of CNS and liver tissue is present [4]. An empiric treatment with aciclovir (Table 2) has been recommended in neonates with (1) typical HSV lesions of the skin, eyes or mouth, (2) encephalitis or sepsis with negative bacterial cultures and (3) the combination of hepatitis and pneumonitis [30].…”