title: Fulminant hepatitis following primary herpes simplex virus infection.
abstract: Fulminant hepatic failure (FHF) is a rare but well-recognized complication of primary herpes simplex virus (HSV) infection in immunocompromised patients. Here, we report two cases of acute hepatitis and FHF secondary to primary HSV type 1 infection following renal transplantation in the absence of any mucocutaneous manifestation. High levels of HSV type-1 DNA were detected in the blood. Both patients were seronegative for HSV 1 and HSV 2 immunoglobulin G (IgG) before transplantation, whereas the donor of patient 1 was HSV 1 IgG-positive but had no viremia and the donor of patient 2 was HSV-seronegative. Patient 1 recovered with acyclovir and immunoglobulin whereas patient 2 did not respond and succumbed to death. HSV-seronegative patients are potentially at risk of developing severe primary HSV disease following transplantation, particularly in the absence of routine anti-viral prophylaxis. HSV infection should always be excluded in transplant patients with hepatic dysfunction.
authors.affiliation: Renal Transplant Unit, Royal Free Hospital, London, UK. ammar_midani@yahoo.co.uk
authors.forename: A
authors.initials: A
authors.lastname: Al Midani
authors.forename: J
authors.initials: J
authors.lastname: Pinney
authors.forename: N
authors.initials: N
authors.lastname: Field
authors.forename: C
authors.initials: C
authors.lastname: Atkinson
authors.forename: T
authors.initials: T
authors.lastname: Haque
authors.forename: M
authors.initials: M
authors.lastname: Harber
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D017809:Fatal Outcome; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000472:pathogenicity*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D000212:Acyclovir