Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases.
Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovir-treated patients as compared to 88% in the untreated subjects (P=0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age>40 yr, immunocompromised state, ALT>5,000 U/L, platelet count<75x10(3)/L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.
Norvell
John P
JP
Department of Internal Medicine, Division of Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Blei
Andres T
AT
Jovanovic
Borko D
BD
Levitsky
Josh
J
D000328:Adult; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010506:Periodicals as Topic; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends