Fulminant hepatic failure secondary to acyclovir-resistant herpes simplex virus

Abstract

Liver failure is a frequent and serious complication that causes morbidity and mortality in haematopoietic stem cell transplantation (HCT) recipients. Liver dysfunction in these patients can be related to infectious causes, most common viral hepatitis. We report a case of disseminated acyclovir-resistant herpes simplex virus (HSV) infection following HCT that led to acute liver failure and death. Although rare, HSV hepatitis leads to high morbidity and mortality and should be considered in the differential diagnosis of HCT recipients with marked elevation of hepatic transaminase. Acyclovir is a first-line therapy for HSV infection; however, acyclovir-resistant viral strains should be considered and alternative HSV therapies given in HCT recipients whose HSV infection does not improve on acyclovir therapy.

Figure 1

CT of the abdomen, which demonstrated numerous hypodense liver lesions 0.5–2 cm diameter in size.

Figure 2

Haematoxylin and eosin stain of liver tissue demonstrating multifocal areas of necrosis and haemorrhage with minimal inflammation.

Figure 3

High power view of haematoxylin and eosin stain of liver tissue demonstrating multinucleation and margination of chromatin.

Figure 4

Immunohistochemical nuclear staining of liver tissue demonstrating acyclovir-resistant herpes simplex virus infection in many of the necrotic hepatocytes.