Herpes Simplex Virus Sepsis in a Young Woman with Crohn's Disease.
We present the case of a herpes simplex virus-1 [HSV-1] sepsis with severe herpes hepatitis in a young female treated with triple immunosuppressive therapy [adalimumab, azathioprine, prednisolone] for refractory Crohn's disease [CD]. The patient presented with high fever, generalised abdominal tenderness, strongly elevated transaminases, coagulopathy, and pancytopenia. Comprehensive diagnostics including blood HSV-1 polymerase chain reaction [PCR], liver biopsy, and immunohistochemistry revealed the diagnosis of fulminant herpes hepatitis. HSV-1 positivity of cutaneous lesions proved the disseminated nature of the infection. Early treatment with intravenous acyclovir led to a rapid improvement of the patient's condition and resulted in a full recovery of her liver function. This is the first reported case of HSV-sepsis in a patient with CD. Physicians treating inflammatory bowel disease [IBD] patients with combined immunosuppressive therapy should be aware of the possibility of herpes hepatitis, and early empirical antiviral therapy should be considered in immunosuppressed patients presenting with fever and severe anicteric hepatitis.
Medical Department 1, Charité Universitätsmedizin Berlin, Berlin lea-maxie.haag@charite.de.
Lea-Maxie
LM
Haag
Institute of Virology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin.
Jörg
J
Hofmann
Medical Department 1, Charité Universitätsmedizin Berlin, Berlin.
Lea Isabell
LI
Kredel
Medical Department 1, Charité Universitätsmedizin Berlin, Berlin.
Christina
C
Holzem
Medical Department 1, Charité Universitätsmedizin Berlin, Berlin.
Anja A
AA
Kühl
Institute of Pathology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin.
Eliane T
ET
Taube
Gastroenterologie am Bayerischen Platz, Berlin.
Stefan
S
Schubert
Medical Department 1, Charité Universitätsmedizin Berlin, Berlin.
Britta
B
Siegmund
Medical Department 1, Charité Universitätsmedizin Berlin, Berlin.
Hans-Jörg
HJ
Epple
D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D004359:Drug Therapy, Combination; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis* / Q000276:immunology; D006561:Herpes Simplex / Q000175:diagnosis* / Q000276:immunology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018805:Sepsis / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D055815:Young Adult
D007166:Immunosuppressive Agents
Crohn’s disease; herpes simplex virus; inflammatory bowel disease