title: Fulminant hepatic and multiple organ failure following acute viral tonsillitis: a case report.
abstract: BACKGROUND
  Pyogenic tonsillitis may often be observed in the general Western population. In severe cases, it may require antibiotic treatment or even hospitalization and often a prompt clinical response will be noted. Here we present an unusual case of progressive multiple organ failure including fulminant liver failure following acute tonsillitis initially mistaken for "classic" pyogenic (that is bacterial) tonsillitis.
  
  
  METHODS
  A 68-year-old previously healthy white man was referred with suspicion of pyogenic angina. After tonsillectomy, he developed acute liver failure and consecutive multiple organ failure including acute hemodynamic, pulmonary and dialysis-dependent renal failure. Immunohistopathological analysis of his tonsils and liver as well as serum polymerase chain reaction analyses revealed herpes simplex virus-2 to be the causative pathogen. Treatment included high-dose acyclovir and multiorgan supportive intensive care therapy. His final outcome was favorable.
  
  
  CONCLUSIONS
  Fulminant herpes simplex virus-2-induced multiple organ failure is rarely observed in the Western hemisphere and should be considered a potential diagnosis in patients with tonsillitis and multiple organ failure including acute liver failure. From a clinical perspective, it seems important to note that fulminant herpes simplex virus-2 infection may masquerade as "routine" bacterial severe sepsis/septic shock. This persevering condition should be diagnosed early and treated goal-oriented in order to gain control of this life-threatening condition.
authors.affiliation: Department of Intensive Care Medicine, Inselspital, Bern University Hospital, CH 3010, Bern, Switzerland.
authors.forename: Ursina
authors.initials: U
authors.lastname: Bechtel-Grosch
authors.affiliation: Department of Infectious Diseases, Inselspital, Bern University Hospital, CH 3010, Bern, Switzerland.
authors.forename: Charles
authors.initials: C
authors.lastname: Beguelin
authors.affiliation: Institute of Pathology, University of Bern, CH 3010, Bern, Switzerland.
authors.forename: Sabina
authors.initials: S
authors.lastname: Berezowska
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, CH 3010, Bern, Switzerland.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Dufour
authors.affiliation: Department of Intensive Care Medicine, Inselspital, Bern University Hospital, CH 3010, Bern, Switzerland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.affiliation: Department of Intensive Care Medicine, Inselspital, Bern University Hospital, CH 3010, Bern, Switzerland. joerg.schefold@insel.ch.
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
mesh_terms: D000208:Acute Disease; D000212:Acyclovir / Q000627:therapeutic use*; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003422:Critical Care; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D008099:Liver / Q000821:virology; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000821:virology*; D008297:Male; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000821:virology*; D014069:Tonsillitis / Q000150:complications* / Q000601:surgery / Q000821:virology*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir