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. 2018 Dec 27;5(12):000982.
doi: 10.12890/2018_000982. eCollection 2018.

Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report

Valentine Inthasot  1 , Adonis Goushchi  1 , Silvia Lazzaroni  1 , Alberto Papaleo  1 , Maria Gomez Galdon  2 , Didier Chochrad  3
Affiliations

Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report

Valentine Inthasot et al. Eur J Case Rep Intern Med. .

Abstract

Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive Escherichia coli. After empirical treatment with piperacillin-tazobactam was initiated, the patient's condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.

Learning points: Herpes simplex virus hepatitis should be considered in patients with acute liver failure.This condition can occur even in immunocompetent individuals.Empirical treatment with aciclovir should be initiated in case of clinical suspicion.

Keywords: Acute liver failure; hepatitis; herpes simplex virus; septic shock.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Right: submassive coagulative necrosis involving centrilobular zone 3. The necrotic zone is surrounded by hepatocytes with typical viral inclusions. There is minimal inflammation around the necrosis. Left: the centrolobular vein is spared
Figure 2
Figure 2
Viral nuclear inclusions
Figure 3
Figure 3
Immunostaining for herpes simplex shows infected cells in randomly distributed areas of coagulative necrosis
Figure 4
Figure 4
Immunostaining for herpes simplex (high magnification)
See this image and copyright information in PMC

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