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Case Reports
. 2018 Sep 27:2018:1269340.
doi: 10.1155/2018/1269340. eCollection 2018.

Acute Liver Failure due to Disseminated Varicella Zoster Infection

Elizabeth Caitlin Brewer  1 , Leigh Hunter  1
Affiliations
Case Reports

Acute Liver Failure due to Disseminated Varicella Zoster Infection

Elizabeth Caitlin Brewer et al. Case Reports Hepatol. .

Abstract

Acute liver failure (ALF) can be due to numerous causes and result in fatality or necessitate liver transplantation if left untreated. Possible etiologies of ALF include ischemia, venous obstruction, medications, toxins, autoimmune hepatitis, metabolic and infectious causes including hepatitis A-E, varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), and adenovirus with VZV being the most rarely reported. Pathognomonic skin lesions facilitate diagnosis of VZV hepatitis, but definitive diagnosis is secured with liver biopsy, tissue histopathology, culture, and specific VZV polymerase chain reaction (PCR). Antiviral treatment with intravenous acyclovir can be effective if initiated in a timely manner; however, comorbidities and complications frequently result in high mortality, especially in immunocompromised hosts as exemplified in this case presentation.

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Figures

Figure 1
Figure 1
Maculopapular rash.
Figure 2
Figure 2
Crusted vesicle.
Figure 3
Figure 3
Skin biopsy.
Figure 4
Figure 4
Skin biopsy: intact epidermis on one side and lesion on the other.
Figure 5
Figure 5
Skin biopsy: viral cytoplasmic effect including multinucleated cells and marginalization of chromatin.
Figure 6
Figure 6
Hepatocytes with frank necrosis.
Figure 7
Figure 7
Larger foci of hepatocytes with frank necrosis.
Figure 8
Figure 8
Areas of necrosis abutting portal triad with chronic minimal inflammation; no significant steatosis seen and no periportal fibrosis or vasculitis appreciated.
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