Herpes simplex virus hepatitis: An analysis of the published literature and institutional cases

Department of Preventive Medicine, Northwestern University, Evanston, Illinois, United States
Liver Transplantation (Impact Factor: 3.79). 10/2007; 13(10):1428-34. DOI: 10.1002/lt.21250
Source: PubMed

ABSTRACT Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovir-treated patients as compared to 88% in the untreated subjects (P=0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age>40 yr, immunocompromised state, ALT>5,000 U/L, platelet count<75x10(3)/L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.

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    09/2014; 4(3). DOI:10.1002/cld.367
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    Journal of Pediatric Gastroenterology and Nutrition 11/2014; 59(5):616-23. DOI:10.1097/MPG.0000000000000512 · 2.87 Impact Factor
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    ABSTRACT: Herpes simplex hepatitis is a rare cause of acute hepatitis in immunocompetent patients. The triad of fever, increase in liver enzymes and leucopenia is suggestive of herpes simplex hepatitis. Delayed diagnosis without antiviral therapy contributes significantly to an unfavorable outcome.
    La Revue de Médecine Interne 12/2014; DOI:10.1016/j.revmed.2013.07.009 · 1.32 Impact Factor

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