Successful treatment of neonatal herpes simplex-type 1 infection complicated by hemophagocytic lymphohistiocytosis and acute liver failure.
Neonatal disseminated herpes simplex virus (HSV) infection with acute liver failure (ALF) and neonatal hemophagocytic lymphohistiocytosis (HLH) are severe diseases. We recently experienced a male infant with HLH and ALF induced by HSV type 1 (HSV-1). The infant, born at 39 weeks of gestation by normal delivery, developed a fever on day 4. On day 9, laboratory investigations showed progressive liver dysfunction and coagulopathy, and the serum ferritin was excessively elevated. Furthermore, the blood levels of interleukin (IL)-6, IL-10, and interferon-gamma were also elevated. HSV-1 DNA was detected in the serum and cerebrospinal fluid by the real-time PCR method. A diagnosis of HLH was established based upon the following criteria: fever, splenomegaly, cytopenia (two cell lines), serum ferritin (> 500 mug/l) and hypofibrinogenemia (< 150 mg/dl). High-dose acyclovir therapy, steroid pulse therapy using methylprednisolone, high-dose gamma globulin therapy and a blood transfusion were given. The patient recovered without neurological deficit. Neonatal disseminated HSV infections may be complicated by the development of HLH and hypercyokinemia. If HLH is suspected, not only high-dose acyclovir therapy but also anti-cytokine therapy should be considered.
Yamada
Keitaro
K
Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan. keitaro_ymd1976@yahoo.co.jp
Yamamoto
Yutaka
Y
Uchiyama
Atsushi
A
Ito
Reiko
R
Aoki
Yusuke
Y
Uchida
Yasushi
Y
Nagasawa
Hiroyuki
H
Kimura
Hiroshi
H
Ichiyama
Takashi
T
Fukao
Toshiyuki
T
Kohno
Yoshinori
Y
D000212:Acyclovir / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D003128:Coma / Q000150:complications; D016207:Cytokines / Q000037:antagonists & inhibitors / Q000097:blood; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D015600:Glasgow Coma Scale; D006561:Herpes Simplex / Q000150:complications* / Q000628:therapy*; D018259:Herpesvirus 1, Human; D006801:Humans; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000150:complications* / Q000628:therapy*; D008111:Liver Function Tests; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D005719:gamma-Globulins / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D016207:Cytokines; D004279:DNA, Viral; D005719:gamma-Globulins; D000212:Acyclovir; D008775:Methylprednisolone