Herpes Simplex Virus (HSV) in the Differential for Fulminant Hepatic Failure

Kevin Ergle, Lawrence Caruso, Martha Burt, Bobby Desai, Rohit Patel

University of Florida Health, Gainesville, USA.

DOI: 10.4236/crcm.2015.42015                

Abstract

Following an elective transphenoidal resection of a pituitary tumor, a 66-year-old Hispanic male acutely developed fulminant hepatic failure and severe coagulopathy. He received parenteral corticosteroids the day prior to surgery, and was first noted to have significant coagulopathy intraoperatively. Despite aggressive workup and treatment for fulminant hepatic failure, the patient developed multiorgan failure by post-operative day 2, and expired on post-operative day 3. On post-mortem examination, hemorrhagic necrosis of the liver was noted and microscopic examination revealed Cowdry type A inclusions, consistent with Herpes Simplex Virus (HSV) infection. This diagnosis was subsequently confirmed by immunehistochemistry. Fulminant hepatic failure due to HSV is a rare but highly fatal disease if untreated. Most case reports include only immunocompromised or pregnant patients. However, the lack of clinical suspicion in this previously healthy patient may have delayed prompt treatment with antiviral agents. It is important to raise the awareness of this rare and life-threatening, but potentially treatable, etiology when clinicians are faced with acute idiopathic fulminant hepatic failure.

Keywords

Fulminant Hepatic Failure, HSV

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Xu, F., Sternberg, M.R., Kottiri, B.J., et al. (2006) Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States. JAMA, 296, 964-973. http://dx.doi.org/10.1001/jama.296.8.964
[2]	Schiodt, F.D.T., Shakil, O., McGuire, B., Samuel, G. and Lee, W., The Acute Liver Failure Study Group (2003) Viral Hepatitis-Related Acute Liver Failure. American Journal of Gastroenterology, 98, 448-453. http://dx.doi.org/10.1016/S0002-9270(02)05891-4
[3]	Flewett, T.H., Parker, R.G. and Philip, W.M. (1969) Acute Hepatitis Due to Herpes Simplex Virus in an Adult. Journal of Clinical Pathology, 22, 60-66. http://dx.doi.org/10.1136/jcp.22.1.60
[4]	Riediger, C., Sauer, P., Matevossian, E., Muller, M.W., Buchler, P. and Friess, H. (2009) Herpes Simplex Virus Sepsis and Acute Liver Failure. Clinical Transplantation, 23, 37-41. http://dx.doi.org/10.1111/j.1399-0012.2009.01108.x
[5]	Aboguddah, A., Stein, H.B., Phillips, P., Amar, J. and English, R. (1991) Herpes Simplex Hepatitis in a Patient with Psoriatic Arthritis Taking Prednisone and Methotrexate. Report and Review of the Literature. Journal of Rheumatology, 18, 1406-1412.
[6]	Norvell, J., Blei, A., Jovanovic, B. and Levitsky, J. (2007) Herpes Simplex Virus Hepatitis: An Analysis of the Published Literature and Institutional Cases. Liver Transplantation, 13, 1428-1434. http://dx.doi.org/10.1002/lt.21250
[7]	Peters, D., Greene, W., Ruggiero, F. and McGarrity, T. (2000) Herpes Simplex-Induced Fulminant Hepatitis in Adults: A Call for Empiric Therapy. Digestive Diseases and Sciences, 45, 2399-2404. http://dx.doi.org/10.1023/A:1005699210816
[8]	Farr, R.W., Short, S. and Weissman, D. (1997) Fulminant Hepatitis during Herpes Simplex Virus Infection in Apparently Immunocompetent Adults: Report of Two Cases and Review of the Literature. Clinical Infectious Diseases, 24, 1191-1194. http://dx.doi.org/10.1086/513646
[9]	Beersma, M.F.C., Verjans, G.M., van Doornum, G.J., et al. (2011) Quantification of Viral DNA and Liver Enzymes in Plasma Improves Early Diagnosis and Management of Herpes Simplex Virus Infection. Journal of Viral Hepatitis, 18, 160-166. http://dx.doi.org/10.1111/j.1365-2893.2010.01352.x
[10]	Biancofiore, G., Bisa, M., Bindi, L.M., et al. (2007) Liver Transplantation Due to Herpes Simplex Virus-Related Sepsis Causing Massive Hepatic Necrosis after Thoracoscopic Thymectomy. Minerva Anestesiologica, 73, 319-322.
[11]	Hiestand, P.C., Mekler, P., Nordmann, R., et al. (1986) Prolactin as a Modulator of Lymphocyte Responsiveness Provides a Possible Mechanism of Action for Cyclosporine. Proceedings of the National Academy of Sciences of the United States of America, 83, 2599. http://dx.doi.org/10.1073/pnas.83.8.2599
[12]	Longerich, T., Eisenbach, C., Penzel, R., et al. (2005) Recurrent Herpes Simplex Virus Hepatitis after Liver Retransplantation Despite Acyclovir Therapy. Liver Transplantation, 11, 1289-1294. http://dx.doi.org/10.1002/lt.20567