A fatal case of herpes simplex virus hepatitis in a pregnant patient

Abstract

We present a middle aged pregnant woman who developed signs and symptoms of acute liver failure and was found to have herpes simplex virus hepatitis. Patient had an emergent delivery and was started on antiviral therapy, but unfortunately due to the severity of her liver failure, she passed away. The importance of reporting this case is to emphasize on the importance of considering herpes simplex infection in pregnant women who present with acute liver failure, and the importance of early administration of antiviral therapy.

Keywords: Herpes simplex hepatitis; acute liver failure; hepatitis in pregnancy.

Figure 1.

The clinical course of the case. The case with acute liver failure due to HSV developed rapidly progressive clinical deterioration despite empiric administration of acyclovir and passed away (†: time of death).

Figure 2.

The autopsy findings. (A) The cut surface of the liver demonstrated innumerable 2–4 mm cream colored, soft nodules; (B) On histopathology, these proved to represent foci of geographic necrosis, highlighted here with an HSV immunostain; (C) High power photomicrograph demonstrates two hepatocytes with typical HSV cytopathic effect (arrows) characterized by multinucleation, margination (i.e., peripheral displacement) of chromatin, and ground-glass nuclei.