Fulminant Herpes Simplex Hepatitis Secondary to Adalimumab in Crohn's Disease: A Case Report

Abstract

Herpes simplex virus (HSV) hepatitis is an uncommon cause of fulminant hepatic failure, seen mostly in immunocompromised patients. Conventional treatment modalities for inflammatory bowel disease (IBD), such as steroids and azathioprine, have been known to cause HSV hepatitis. However, the reported incidence of HSV hepatitis in IBD patients undergoing tumor necrosis factor (TNF)-α inhibitor therapy is very rare. In this case report, we describe a rare case of fulminant HSV hepatitis that developed in a patient with Crohn's disease after treatment with the TNF-α inhibitor, adalimumab.

Keywords: Crohn’s disease; TNF-α inhibitor; adalimumab; hepatitis; herpes simplex virus; inflammatory bowel disease.

Figure 1.

Postmortem histological section from liver showing confluent massive necrosis with minimal inflammation (A). At higher power, large ground-glass nuclei are seen (B).

Figure 2.

Strong and diffusely positive immunohistochemical staining for HSV in liver.

Figure 3.

Focal necrosis (A), with patchy HSV–immunohistochemical positivity (B) in the spleen.