Ewha Med J.  2016 Jul;39(3):81-84. 10.12771/emj.2016.39.3.81.

Herpes Simplex Virus Hepatitis Treated with Acyclovir

• Jeong BJ
• Tae HJ
• Cho YJ
• Kang YM
• Lee E
• Han SJ
• Shin JM

• KMID: 2344896
• DOI: http://doi.org/10.12771/emj.2016.39.3.81

Abstract

Herpes simplex viruses (HSVs) are the most common cause of mucocutaneous infections with dissemination to visceral organs. HSV-induced hepatitis is a rare but frequent cause of hepatitis in immunocompromised patients, pregnant women, and newborns. However, diagnosis is often difficult because the clinical features are nonspecific. In addition, the HSV-related mortality rate is high. Signs and symptoms of HSV include fever, anorexia, nausea, vomiting, abdominal pain or tenderness, leukocytopenia, coagulopathy, and an increase in serum transaminase levels without jaundice. We present a patient who did not correspond to the above symptoms, but survived following prompt intravenous high-dose acyclovir provided early in the course of the disease.

Keyword

Herpes simplex virus; Fulminant hepatic failure; Acyclovir

MeSH Terms

Abdominal Pain
Acyclovir*
Anorexia
Diagnosis
Female
Fever
Hepatitis
Herpes Simplex*
Humans
Immunocompromised Host
Infant, Newborn
Jaundice
Leukopenia
Liver Failure, Acute
Mortality
Nausea
Pregnant Women
Simplexvirus*
Vomiting
Acyclovir

Figure

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  Fig. 1 Doppler ultrasound of the liver. Heterogeneous echo texture of the liver as well as blood flow in the normal direction in the major hepatic vessels are remarkable.

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  Fig. 2 Abdominal computed tomography. (A) In coronal view, it shows periportal tracking in liver. (B) In axial view, it shows a small amount of ascites, diffuse heterogeneous enhancement of the liver with a few tiny small nodules.

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  Fig. 3 Light microscopic finding of liver biopsy. It reveals reactive changes of hepatocytes and lobular necrosis associated with mild cholestasis (H&E, ×400).

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  Fig. 4 Response to treatment in case. It shows improvement in transaminases following treatment with intravenous acyclovir. HD, hospital day; AST, aspartate aminotransferase; SGOT, serum glutamic oxaloacetic transaminase; ALT, alanine transaminase; SGPT, serum glutamic pyruvic transaminase; OPD, outpatient department.

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