Fatal disseminated herpes simplex virus infection in a previously healthy pregnant woman. A case report.
BACKGROUND
In contrast to the frequent occurrence of localized herpes simplex virus (HSV) infections during pregnancy, disseminated disease has rarely been reported.


METHODS
A 21-year-old woman in the 27th week of gestation developed a catastrophic illness characterized by fever, progressive pneumonia, respiratory failure, leukopenia, disseminated intravascular coagulation (DIC), anicteric hepatitis, septic shock and acute renal failure. Initial studies for an infectious etiology were negative. In spite of empiric broad-spectrum antimicrobial therapy, her condition continued to deteriorate. Sparse vesicular skin lesions suggestive of HSV infection subsequently appeared. Despite initiation of acyclovir therapy, the patient died. HSV type 2 was cultured from a skin vesicle, and at autopsy there was extensive necrosis of the liver and lung with immunohistochemical stains positive for HSV antigen.


CONCLUSIONS
In the third trimester of pregnancy, HSV can occasionally disseminate in immunocompetent women. A clinical syndrome of unexplained fever, pneumonia, anicteric hepatitis, leukopenia and DIC without mucocutaneous lesions should prompt investigation and possible treatment for disseminated HSV infection.
Frederick
Dexter M
DM
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Loma Linda University, School of Medicine, Loma Linda, California, USA.
Bland
David
D
Gollin
Yvonne
Y
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000956:Antigens, Viral / Q000302:isolation & purification; D000998:Antiviral Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006561:Herpes Simplex / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011263:Pregnancy Trimester, Third; D014766:Viremia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
D000956:Antigens, Viral; D000998:Antiviral Agents; D000212:Acyclovir