Primary herpes simplex virus type-2 infection as a cause of liver failure after liver transplantation.
We report a case of fatal primary herpes simplex virus type-2 (HSV-2) infection following liver transplantation, which manifested with fever and liver failure in the absence of muco-cutaneous disease. The infection was characterized by high levels of HSV DNA in blood and the patient's inability to mount HSV-specific T-cell responses while showing preserved T-cell responses against cytomegalovirus. The donor was HSV-1 immunoglobulin G (IgG) seronegative and HSV-2 IgG seropositive, whereas the recipient was HSV-1 and HSV-2 IgG seronegative, suggesting that the graft may have been the source of the infection. In HSV-seronegative recipients of grafts from HSV-seropositive donors, HSV infection should be included in the differential diagnosis of a febrile illness, regardless of the absence of muco-cutaneous disease. In this setting, real-time polymerase chain reaction applied to blood samples provides a sensitive, rapid, and quantitative diagnostic tool.
Nebbia
G
G
Department of Virology, Royal Free and University College Hospital, London, UK.
Mattes
F M
FM
Ramaswamy
M
M
Quaglia
A
A
Verghese
G
G
Griffiths
P D
PD
Burroughs
A
A
Geretti
A M
AM
D000328:Adult; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000209:etiology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D017093:Liver Failure / Q000821:virology*; D016031:Liver Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction / Q000379:methods