Abstract
Herpes simplex-induced fulminant hepatitis is an infrequently reported cause of hepatitis in adults. Pregnant females and patients with impaired cellular immunity may be at increased risk, although healthy adults have been affected. The diagnosis may be underrecognized due to nonspecific presenting symptoms and lack of typical cutaneous herpes lesions. We present three cases of fatal herpes simplex fulminant hepatitis. Our review of case reports of herpes simplex hepatitis in adults demonstrates improved survival with intravenous acyclovir therapy. We believe that empiric use of acyclovir should be considered while the diagnostic evaluation of non-acetaminophen-induced fulminant hepatitis is underway. Recognition of characteristic liver function abnormalities seen with fulminant herpes simplex hepatitis include marked elevation of transaminases with AST > ALT and a mild hyperbilirubinemia (anicteric hepatitis), and they should prompt acyclovir therapy. This is especially true when there are no obvious risk factors for other forms of hepatitis.
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REFERENCES
Glorioso DV, Molloy PJ, Van Thiel, DH, Kania RJ: Successful empiric treatment of HSV hepatitis in pregnancy. Case report and review of the literature. Dig Dis Sci 41:1273-1275, 1996.
Kusne S, Schwartz M, Breinig MD, et al: Herpes simplex virus hepatitis after solid organ transplantation in adults. J Infect Dis 163:1001-1007, 1991.
Williams R, Wendon J: Indications for orthotopic liver transplantation in fulminant liver failure. Hepatology 20:5S-10S, 1994.
O'Grady JG, Portmann B, Williams R: Fulminant hepatic failure. In L Schiff, ER Schiff (eds). Philadelphia, Lippincott Company 1993, pp 1077-1090.
Flewett TH, Parker RGF, Philip WM: Acute hepatitis due to herpes simplex virus in an adult. J Clin Pathol 22:60-66, 1969
Fink CG, Read SJ, Hopkin J, Peto T, Gould S, Kurtz JB: Acute herpes hepatitis in pregnancy. J Clin Pathol 46:968-971, 1993
Lagrew DC, Furlow TG, Hager WD, Yarrish RL: Disseminated herpes simplex virus infection in pregnancy. Successful treatment with acyclovir. JAMA 252:2058-2059, 1984
Greenspoon JS, Wilcox JG, McHutchison LB, Rosen DJD: Acyclovir for disseminated herpes simplex virus in pregnancy. J Reprod Med 39:311-317, 1994
Klein NA, Mabie WC, Shaver DC, et al: Herpes simplex virus hepatitis in pregnancy. Two patients successfully treated with acyclovir. Gastroenterology 100:239-244, 1991
Kaufman B, Gandhi SA, Loui E, Rizzi R, Illei P: Herpes simplex virus hepatitis: Case report and review. Clin Infect Dis 24:334-338, 1997
Yaziji H, Hill T, Pittman TC, et al: Gestational herpes simplex virus hepatitis. South Med J 90:347-351, 1997
Eron L, Kosinski K, Hirsch MS: Hepatitis in an adult caused by herpes simplex virus type I. Gastroenterology 71:500-504, 1976
Goyert GL, Bottoms SF, Sokol RJ: Anicteric presentation of fatal herpetic hepatitis in pregnancy. Obstet Gynecol 65:585-588, 1985
Tomita T, Garcia F, Mowry M: Herpes simplex hepatitis before and after acyclovir treatment. Arch Pathol Lab Med 116:173-177, 1992
Whitley RJ, Roizman B: Herpes simplex viruses. Clin Virol 18:375-400, 1997
Chase RA, Pottage JC, Haber MH, Kistler G, Jensen D, Levin S: Herpes simplex viral hepatitis in adults: Two case reports and review of the literature. Rev Infect Dis 9:329-333, 1987
Aboguddah A, Stein HB, Phillips P, Amar J, English R: Herpes simplex hepatitis in a patient with psoriatic arthritis taking prednisone and Methotrexate. Report and review of the literature. J Rheumatol 18:1406-1412, 1991
Whitley R, Arvin A, Prober C, et al: A controlled trial comparing Vidarabine with acyclovir in neonatal herpes simplex virus infection. N Engl J Med 324:444-449, 1991
Johnson LG, Saldana LR: Herpes simplex virus hepatitis in pregnancy. J Reprod Med 39:544-546, 1994
Shanley CJ, Braun DK, Brown K, et al: Fulminant hepatic failure secondary to herpes simplex virus hepatitis. Transplantation 59:145-149, 1995
Baxter RP, Phillips LE, Faro S, Hoffman L: Hepatitis due to herpes simplex virus in a nonpregnant patient: Treatment with acyclovir. Sec Trans Dis 13:174-176, 1986
Mudido P, Marshall GS, Howell RS, et al: Disseminated herpes simplex virus infection during pregnancy. J Reprod Med 38:964-968, 1993
Thomas CA, Smith SE, Morgan TM, Write WL, Feldmcu JR: Clinical application of PCR amplification to diagnosis of herpes virus infection. Am J Dermatopathol 1994;16:268-274
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Peters, D.J., Greene, W.H., Ruggiero, F. et al. Herpes Simplex-Induced Fulminant Hepatitis In Adults. Dig Dis Sci 45, 2399–2404 (2000). https://doi.org/10.1023/A:1005699210816
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DOI: https://doi.org/10.1023/A:1005699210816