Fulminant Hepatic Failure due to Herpes Simplex Virus in a Previously Healthy Woman: Case Report and Review of the Literature

Abstract: Hepatitis due to herpes simplex virus in immunocompetent adults is a rare and rapidly fatal disease that presents an urgent diagnostic challenge. With few distinguishing clinical features, herpes simplex hepatitis is seldom considered in the differential diagnosis of acute hepatitis; yet case reports suggest that early diagnosis and prompt initiation of antiviral therapy may halt the typical progression to hepatic failure and death. A case of herpes simplex hepatitis leading to fulminant hepatic failure and death within 48 hours of admission in a previously healthy young woman is presented and compared with previously reported cases. Review of known cases occurring in healthy adults suggests that fever, leukopenia, and elevated transaminases, often with thrombocytopenia or evidence of oral, urethral, or vaginal inflammation, should prompt a high clinical suspicion for herpes simplex hepatitis because typical herpetic mucocutaneous lesions are uncommon. Liver biopsy appears to be the most successful means of antemortem diagnosis. Early therapy with acyclovir may be of benefit in this frequently mortal disease.