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Case Reports
. 2021 Aug 3:22:e932474.
doi: 10.12659/AJCR.932474.

Disseminated Herpes Simplex Virus-2 (HSV-2) as a Cause of Viral Hepatitis in an Immunocompetent Host

Dushyanth Srinivasan  1 , Christina M Kaul  2 , Amna B Buttar  3 , Fatima I Nottingham  1 , Jeffrey B Greene  2
Affiliations
Case Reports

Disseminated Herpes Simplex Virus-2 (HSV-2) as a Cause of Viral Hepatitis in an Immunocompetent Host

Dushyanth Srinivasan et al. Am J Case Rep. .

Abstract

BACKGROUND Herpes simplex virus-2 (HSV-2) affects nearly 1 in 5 adults in the United States. Complications such as viral hepatitis and dissemination are rare in immunocompetent hosts. In this report, we describe a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent patient with recurrent fevers and elevated aminotransferases. CASE REPORT A 57-year-old man with a history of type 2 diabetes and hypertension was admitted with a right index finger lesion concerning for an abscess. He underwent successful incision and drainage and was started on ampicillin-sulbactam. On Day 2 of hospitalization, he developed recurrent fevers and elevated aminotransferases and inflammatory markers. An extensive infectious, rheumatologic, and malignancy workup were pursued without immediate findings. Imaging demonstrated cirrhotic morphology of the liver and splenomegaly, but lab markers were intact for liver synthetic function. On Day 7 of hospitalization, fever frequency decreased, and HSV-2 titers resulted, with positive IgM and negative IgG. He subsequently developed erythematous, raised lesions in multiple dermatomes. Nucleic acid amplification testing of biopsied lesions was positive for HSV-2, confirming viral hepatitis secondary to disseminated HSV-2. He was started on intravenous acyclovir and discharged on valacyclovir following improvement in symptoms. CONCLUSIONS We report a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent host. Up to 25% of cases occur in immunocompetent hosts and many patients do not develop characteristic skin lesions. Early diagnosis and treatment of viral hepatitis secondary to disseminated HSV remains vital to minimize morbidity and mortality.

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Conflict of interest statement

Conflict of interest: None declared

Conflict of Interest

None .

Figures

Figure 1.
Figure 1.
Right erythematous papule on initial presentation was thought to be an abscess.
Figure 2.
Figure 2.
CT Abdomen and pelvis demonstrating cirrhotic morphology of the liver, splenomegaly, and splenic lesions.
Figure 3.
Figure 3.
4 mm clear vesicle with erythematous base on right ulnar dorsal hand.
Figure 4.
Figure 4.
3 mm vesicle with erythematous base on right medial thigh.
Figure 5.
Figure 5.
4–7 mm multiple erythematous macules on left tricep.
Figure 6.
Figure 6.
Multiple tiny vesicles with crusting overlaying suprapubic region.
See this image and copyright information in PMC

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