title: A unique presentation of acute liver failure from herpes simplex virus hepatitis.
abstract: We present the case of a patient, with history of myelodysplastic syndrome and recent bone marrow transplant, who developed fulminant liver failure secondary to herpes simplex virus (HSV) hepatitis. His presentation was unique, as findings of liver microabscesses on computed tomography scan have not been described previously in this patient population. Despite initial treatment with acyclovir, he continued to deteriorate, and later sensitivities found the HSV strain to be resistant to acyclovir. HSV hepatitis with secondary liver failure is rare and, without appropriate treatment, its mortality is >80%. Early suspicion and immediate therapy are the keys to improve patient survival.
authors.affiliation: Department of Critical Care, Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: C
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Department of Stem Cell Transplantation, Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: P
authors.initials: P
authors.lastname: Kebriaei
authors.affiliation: Department of Critical Care, Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Turner
authors.affiliation: Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: A
authors.initials: A
authors.lastname: Yemelyanova
authors.affiliation: Department of Infectious Disease, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Ariza-Heredia
authors.affiliation: Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: W C
authors.initials: WC
authors.lastname: Foo
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D024882:Drug Resistance, Viral; D017809:Fatal Outcome; D017245:Foscarnet / Q000008:administration & dosage / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000150:complications / Q000188:drug therapy; D006525:Hepatitis, Viral, Human / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology; D017114:Liver Failure, Acute / Q000097:blood / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000601:surgery*; D000070659:Patient Comfort; D016133:Polymerase Chain Reaction; D018139:Simplexvirus / Q000302:isolation & purification*; D000637:Transaminases / Q000097:blood; D014184:Transplantation, Homologous / Q000009:adverse effects; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D017245:Foscarnet; D000637:Transaminases; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir
keywords: acute liver failure; acyclovir; hepatitis; herpes simplex virus; liver microabscesses