Herpes simplex virus hepatitis causing acute liver dysfunction and thrombocytopenia in pregnancy.
BACKGROUND
Herpes simplex virus (HSV) hepatitis in pregnant women is a rare condition. We report a case confirmed by liver biopsy and successfully treated with empiric intravenous acyclovir.


METHODS
A 25-year-old primigravida at 34 weeks of gestation presented with fever, thrombocytopenia, and markedly elevated liver enzymes. The patient was treated empirically and was delivered by cesarean. After delivery failed to correct her condition, a liver biopsy revealed HSV hepatitis. The fetus was unaffected and the patient recovered with an extended course of acyclovir.


CONCLUSIONS
Pregnant women are susceptible to disseminated HSV causing hepatitis. A high index of suspicion is necessary to diagnose HSV hepatitis and begin appropriate treatment with acyclovir. Herpes simplex virus hepatitis should be included in the differential diagnosis for liver failure during pregnancy.
Allen
Rebecca H
RH
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. rallen@partners.org
Tuomala
Ruth E
RE
D000212:Acyclovir / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D002585:Cesarean Section; D003937:Diagnosis, Differential; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006561:Herpes Simplex / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000503:physiopathology / Q000821:virology; D017093:Liver Failure / Q000209:etiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011256:Pregnancy Outcome; D018139:Simplexvirus / Q000302:isolation & purification; D013921:Thrombocytopenia / Q000209:etiology
D000998:Antiviral Agents; D000212:Acyclovir