Fatal multiorgan failure associated with disseminated herpes simplex virus-1 infection: a case report

Abstract

Herpes simplex virus type 1 (HSV-1) infections cause typical dermal and mucosal lesions in children and adults. Also complications to the peripheral and central nervous system, pneumonia or hepatitis are well known. However, dissemination to viscera in adults is rare and predominantly observed in immunocompromised patients. Here we describe the case of a 70-year-old male admitted with macrohematuria and signs of acute infection and finally deceasing in a septic shock with multi organ failure 17 days after admission to intensive care unit. No bacterial or fungal infection could be detected during his stay, but only two days before death the patient showed signs of rectal, orolabial and genital herpes infection. The presence of HSV-1 was detected in swabs taken from the lesions, oropharyngeal fluid as well as in plasma. Post-mortem polymerase chain reaction analyses confirmed a disseminated infection with HSV-1 involving various organs and tissues but excluding the central nervous system. Autopsy revealed a predominantly retroperitoneal diffuse large B-cell lymphoma as the suspected origin of immunosuppression underlying herpes simplex dissemination.

Figure 1

Orolabial vesicles and ulcers. Appearance of orolabial vesicles and ulcers on day 17 of ICU treatment, two days before death (percutaneous tracheotomy was performed on day 7).

Figure 2

Autopsy revealed a massive retroperitoneal lymphoma. Giant retroperitoneal lymphoma masses enclosing abdominal aorta [§], inferior vena cava [#] and leading to stenosis of the right ureter [∗]. Tissue was formalin fixed.