Article

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: 4.24). 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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Available from: John Paul Norvell, Oct 15, 2014
    • "Coagulopathy, thrombocytopenia and leucopenia were common laboratory findings in more than 70% of the cases. Acute tubular necrosis was reported in almost 65% of the HSV hepatitis patients [4]. In addition, fulminant hepatic failure (FHF) due to HSV-1 infection is usually marked by significant elevations in transaminases (AST levels higher than ALT), and a mild or absent hyperbilirubinemia [2], as seen in our patient. "

    No preview · Article · Apr 2015 · Journal of Clinical Virology
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    • "L'évolution spontanée des insuffisances hépatiques aiguës secondaires aux virus herpétiques est défavorable dans la quasi totalité des cas, avec un taux de mortalité qui varie entre 50 % et 90 %, selon la rapidité du diagnostic et la précocité du traitement antiviral [3] [5] [10] [15]. Les virus herpès représentent la moitié des indications de transplantation hépatique pour les hépatites virales fulminantes [3]. Les facteurs prédictifs de mortalité et de transplantation hépatique pour les patients atteints d'une hépatite herpétique sont : l'âge avancé, le sexe masculin, l'immunodépression, la cytolyse importante, la coagulopathie de consommation et l'encéphalopathie [3]. "
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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.
    Full-text · Article · Dec 2014 · La Revue de Médecine Interne
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    • "L'évolution spontanée des insuffisances hépatiques aiguës secondaires aux virus herpétiques est défavorable dans la quasi totalité des cas, avec un taux de mortalité qui varie entre 50 % et 90 %, selon la rapidité du diagnostic et la précocité du traitement antiviral [3] [5] [10] [15]. Les virus herpès représentent la moitié des indications de transplantation hépatique pour les hépatites virales fulminantes [3]. Les facteurs prédictifs de mortalité et de transplantation hépatique pour les patients atteints d'une hépatite herpétique sont : l'âge avancé, le sexe masculin, l'immunodépression, la cytolyse importante, la coagulopathie de consommation et l'encéphalopathie [3]. "
    [Show abstract] [Hide abstract]
    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. We report a 50-year old immunocompetent male patient, who presented with acute severe hepatitis due to a reactivation of a herpes simplex infection with a complicated course including macrophage activation syndrome and severe coagulopathy. Outcome was finally favorable with early acyclovir therapy. Despite its relatively low occurrence rate, diagnosis of herpetic hepatitis should be discussed in immunocompetent patients with acute liver failure. The benefit of an early acyclovir treatment should lead clinicians to consider this uncommon diagnosis in unexplained cases of hepatitis and to test rapidly HSV DNA levels by PCR in plasma.
    Full-text · Article · Aug 2013 · La Revue de Médecine Interne
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