Disseminated Herpes Simplex Virus with Fulminant Hepatitis

Phytomedicine. The outcome in these patients is primarily determined by the underlying cardiopulmonary disease, and liver transplantation is rarely required or indicated. Journal of Clinical Gastroenterology. 30. doi:10.1016/S0022-5347(01)64525-7. While the actual site of latency has yet to be established, monocytes,14 macrophages, and early bone marrow progenitor cells20 are likely sites for persistence. ^ Anthony SJ, St Leger JA, Liang E, Hicks AL, Sanchez-Leon MD, Jain K, Lefkowitch JH, Navarrete-Macias I, Knowles N, Goldstein T, Pugliares K, Ip HS, Rowles T, Lipkin WI (2015).

Chronic persistent infections of hepatitis C (HCV) and type D virus (HDV) is found throughout the world. EBV has been implicated as a cause of hemophagocytic lymphohistiocytosis, a multi-system syndrome resulting from uncontrolled immune activation and macrophage proliferation [33]. Your GP can give advice and may examine you. The incidence of HBV infection and patterns of transmission vary greatly throughout the world, depending on local endemicity, with rates between 0.1 and 120 per 100,000. These findings parallel results from other studies that have consistently found that a large percentage of the population is not aware of their serostatus due to the asymptomatic nature of these infections [11,28]. Intranuclear virions were of smaller size (108 nm) than cytoplasmic virions (average size 139 nm excluding spikes). Approximately 12%-35% of patients are asymptomatic at diagnosis and in such cases AIH is usually documented during a random investigation for elevated transaminases which has been done for different reasons (e.g., annual check-up for insurance, investigation for other pathological entities, etc.)[22,71,75-77,84,85].

These tests should be done as soon as possible after the exposure and should occur simultaneously. Arrhythmias are another manifestation of AHF. Approximately 35% of all AIH type 1 cases demonstrate SMA positivity alone [78, 81], whereas 55% to 60% of the cases demonstrate both ANA and SMA positivity [78, 81]. Laboratory investigations often show leucopenia, thrombocytopenia, and coagulopathy [3–6, 8–10]. The disease is self-limited, and neither a carrier state nor chronic infections have been identified. At this time, however, HSV PCR is still largely performed only at reference laboratories with results often not available in time to guide clinical management [7, 17]. Healthcare providers should be aware of HSV hepatitis in patients with elevated liver enzymes even in the absence of suggestive cutaneous features, as empiric therapy can prevent further morbidity and mortality.

In contrast to this, our patient’s imaging more closely resembled hepatic pyogenic abscesses, typically characterized by larger hypodense lesions or, as seen in our patient, small clustered hypodense lesions with rim enhancement [16]. Hypersensitivity reaction starts within 2 – 3 weeks of drug exposure, whereas sinusoidal endothelial damage can occur anytime between 3 months and 3 years of treatment [13]. Kamar N, Selves J, Mansuy JM, Ouezzani L, Péron JM, Guitard J, et al. While liver biopsy has historically been the gold standard for diagnosis of HSV hepatitis, serum HSV PCR is becoming the diagnostic modality of choice with a high sensitivity and specificity [4]. No cause for her liver failure was identified. HSV hepatitis has been described during both recurrent and primary HSV infection in immunocompromised hosts [3,4]. 29, 2015.

They are also the source of serum immunoglobulins. Doctors typically prescribe prednisone at a high dose for about the first month of treatment. (A) In coronal view, it shows periportal tracking in liver. Her abdomen was soft and nontender with no organomegaly, and her skin was clear. Herpes simplex virus hepatitis causing acute liver dysfunction and thrombocytopenia in pregnancy. Reviews and ratings for valtrex when used in the treatment of herpes simplex, suppression. Association of EM with herpes simplex virus infection; Occurrence of delayed-type hypersensitivity reaction; Composition of classic iris lesions of EM.

Herpes simplex virus must be considered in all patients presenting with liver failure of unknown cause. Other viruses such as CMV, HSV, and EBV are highly prevalent and must be excluded in all cases of NANB hepatitis. Fulminant hepatic failure (FHF) is a rare but well-recognized complication of primary herpes simplex virus (HSV) infection in immunocompromised patients. Changes in the immune system during pregnancy make pregnant patients more susceptible to acute HSV hepatitis, HSV-related ALF, and death. There are many different types of viral hepatitis – A, B, C, D, and E – that specifically infect the liver. She ultimately was diagnosed with disseminated HSV infection, started on definitive therapy, and allowed to continue her pregnancy to term. Subsequent liver biopsy, however, revealed hepatocellular necrosis, HSV-type intranuclear inclusions, and immunostaining positive for herpes virus type 2 (HSV-2).

A computed tomography (CT) scan of the abdomen demonstrated an intramural sigmoid colon abscess and multiple abscesses in the liver. Although carefully collected, accuracy cannot be guaranteed. The authors present a case of HSV hepatitis in a 26-year-old female with focal proliferative lupus nephropathy who was status post one cycle of pulse high-dose (1 gm/ m2) cyclophosphamide. Herpes hepatitis presents with nonspecific symptoms like fever, loss of appetite, vomiting, nausea and abdominal pain.

Disseminated Herpes Simplex Virus with Fulminant Hepatitis

Cohen MR. Acute liver failure is a well known complication of several pregnancy-related liver diseases including acute fatty liver of pregnancy (AFLP) and the syndrome of hemolysis, elevated liver enzyme levels and low platelet count (HELLP) [65-67]. Herpes simplex hepatitis in apparently immunocompetent adults. 29. 1995;345:124–5. “Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study”. Immunohistochemical studies showed that the cells containing the inclusions were CD3/CD4-positive T lymphocytes, and electron microscopic analysis demonstrated numerous viral particles in the cytoplasm and nuclei of the infected cells, consistent with the herpesvirus family.

^ ICTV. Chronic hepatitis develops in about 10–15 percent of hepatitis B patients. Though different histologic patterns of liver injury have been described in EBV infection, the exact mechanism of liver injury in EBV-related ALF remains unclear [29, 30]. Abnormal vaginal bleeding. A. Approximately 30% of infections among adults present as icteric hepatitis, and 0.1–0.5% of patients develop fulminant hepatitis. Individuals who reported a history of other STIs and those with a history of imprisonment were also significantly more likely to be HSV-2 seropositive than those without such histories (33.9% vs.

1 and was negative. However, it is now well-established that AIH has a global distribution, can also affect males (almost 25%-30% of the patients) and can present at any age and in all ethnic groups[22,26,70-77]. Vaccine responder: If the hepatitis B surface antibody (anti-HBs) level after receiving three to six doses of HepB vaccine is ≥ 10 mIU/mL, the individual is considered a vaccine responder and is thought to be protected against HBV infection. In other patients, the disease actively progresses, eventually leading to cirrhosis and death. Specifically, exposure to alcohol, radiation, and chemicals, such as hydrocarbons and arsenic, have been implicated. Typically, it is a metabolic acidosis and results from the direct effects of hepatotoxic drugs such as APAP. Moreover, no single ANA pattern is dominant in AIH, although a homogenous pattern is typical [79].

Immunostaining was positive for HSV antibodies (Figure 3). The infection therefore only occurs in individuals with a concurrent acute or chronic hepatitis B infection. PCR has emerged as a rapid and sensitive diagnostic tool for verification of disseminated HSV disease and should be utilized on plasma, body fluids, and biopsy specimens when possible (2, 6). Our case describes the rare presentation of HSV hepatitis in a previously healthy, immunocompetent adult and highlights the importance of considering HSV hepatitis in all patients with acute hepatitis with multifocal hepatic lesions of unknown etiology. In this case, the absence of hypertension and the presence of fever made the diagnosis of pregnancy-related disorders, such as HELLP and acute fatty liver of pregnancy, unlikely. Despite its complications, acyclovir can offer promising results as we have described. His hospital course was complicated by small bowel ileus which progressed to partial small bowel obstruction that is thought to be due to opiate-induced peristalsis reduction that improved with conservative management, and he ultimately achieved full clinical recovery.

According to a report, hepatitis A accounts for 7% cases of acute liver failure and hepatitis B for 2% cases [10]. Clinical outcome of HBeAg-negative chronic hepatitis B in relation to virological response to lamivudine. She completed a 21-day course with normalization of her liver function tests, negative follow-up HSV CSF PCR, and resolution of her cutaneous skin lesions at her 1-month follow-up visit. No focus for infection was found, and she was presumed to have a viral illness with a systemic inflammatory response syndrome (SIRS). From this point gradual improvement in the laboratory findings was observed. 20, 2015. Persistent lymphocytosis may be seen in patients with autoimmune disorders, sarcoidosis, hyposplenism, or cancer and in those who are long-term cigarette smokers.

Chronic hepatitis E has been described in liver and kidney transplant recipients [8] and also in some HIV-infected patients [9]. Type A is the most common form of viral hepatitis. The patient had no history of high-risk behaviors such as alcohol abuse, smoking, illicit drug use, or indiscriminate sexual behaviors. The aim of this paper is to review this rare but important cause of liver failure, its clinical presentation, and available treatment options. BJOG 2007; 114: 1113–1121. Since the vast majority of patients with liver herpetic lesions not accompanied by vesicular eruptions on the skin and mucous membranes, the virus is not considered by doctors as a possible etiologic cause of hepatitis, antiviral therapy is not appointed, and many patients die from acuteliver failure.In the case of the appointment of acyclovir empirical immunocompetent and immunocompromised patients it does not occur. Alcohol can reduce the effectiveness of certain medications, as well as increase the risk of side effects, such as dizziness, especially in older adults.

His past medical history was unremarkable. 41-year-old previously healthy female presenting with a nonspecific viral illness and systemic inflammatory response syndrome.