Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis.
We report 5 cases of acute liver failure related to herpes simplex (HSV) infection in 1 immunocompetent and 4 immunosuppressed patients. One patient was too ill for liver transplantation indication. Three patients, among the 4 listed, underwent liver transplantation. Three patients died 11 days to 1 year after transplantation and 2 patients died 2 to 3 days after admission. All presented with fever and none with skin lesions. The diagnosis of HSV-related hepatitis was made antemortem in only 2 patients on the basis of positive blood cultures and/or immunohistochemic findings. In the remaining patients, HSV diagnosis was made retrospectively on further histologic and virologic investigations. Primary HSV infection was certain or likely in all cases, including an HSV2 superinfection of an anti-HSV1-positive patient and two HSV superinfections of hepatitis B virus (HBV)-related chronic liver disease. In these latter patients, HSV diagnosis was totally unsuspected, despite fever. HSV superinfection has significantly contributed to liver dysfunction aggravation and death. In conclusion, the diagnosis of HSV hepatitis is difficult to establish in the absence of specific clinical signs. This may suggest the need for early administration of acyclovir in patients with suspected HSV hepatitis, without waiting for virologic confirmation. Diagnosis methods providing fast results (real-time polymerase chain reaction [PCR]) should be implemented.
Ichai
Philippe
P
Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif Cedex, France. philippe.ichai@pbr.ap-hop-paris.fr
Roque Afonso
Anne Marie
AM
Sebagh
Mylène
M
Gonzalez
Maria Eugenia
ME
Codés
Liana
L
Azoulay
Daniel
D
Saliba
Faouzi
F
Karam
Vincent
V
Dussaix
Elisabeth
E
Guettier
Catherine
C
Castaing
Denis
D
Samuel
Didier
D
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018139:Simplexvirus / Q000276:immunology; D016896:Treatment Outcome
D000914:Antibodies, Viral; D000212:Acyclovir