Fulminant hepatitis following primary herpes simplex virus infection.

TitleFulminant hepatitis following primary herpes simplex virus infection.
Publication TypeJournal Article
Year of Publication2011
AuthorsA Midani A, Pinney J, Field N, Atkinson C, Haque T, Harber M
JournalSaudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia//Saudi J Kidney Dis Transpl
Pagination107 - 11
Date Published2011
ISBN Number1319-2442
Other Numbers9436968
Keywords*Hepatitis, Viral, Human/vi [Virology], *Herpes Simplex/vi [Virology], *Herpesvirus 1, Human/py [Pathogenicity], *Kidney Transplantation/ae [Adverse Effects], *Liver Failure, Acute/vi [Virology], Acyclovir/tu [Therapeutic Use], Adult, Antiviral Agents/tu [Therapeutic Use], Biopsy, Fatal Outcome, Female, Hepatitis, Viral, Human/di [Diagnosis], Hepatitis, Viral, Human/dt [Drug Therapy], Herpes Simplex/di [Diagnosis], Herpes Simplex/dt [Drug Therapy], Herpesvirus 1, Human/ge [Genetics], Humans, Immunoglobulins, Intravenous/tu [Therapeutic Use], Immunosuppressive Agents/tu [Therapeutic Use], Liver Failure, Acute/di [Diagnosis], Liver Failure, Acute/dt [Drug Therapy], Male, Middle Aged, RNA, Viral/bl [Blood], Tomography, X-Ray Computed, Treatment Outcome

Fulminant hepatic failure (FHF) is a rare but well-recognized complication of primary herpes simplex virus (HSV) infection in immunocompromised patients. Here, we report two cases of acute hepatitis and FHF secondary to primary HSV type 1 infection following renal transplantation in the absence of any mucocutaneous manifestation. High levels of HSV type-1 DNA were detected in the blood. Both patients were seronegative for HSV 1 and HSV 2 immunoglobulin G (IgG) before transplantation, whereas the donor of patient 1 was HSV 1 IgG-positive but had no viremia and the donor of patient 2 was HSV-seronegative. Patient 1 recovered with acyclovir and immunoglobulin whereas patient 2 did not respond and succumbed to death. HSV-seronegative patients are potentially at risk of developing severe primary HSV disease following transplantation, particularly in the absence of routine anti-viral prophylaxis. HSV infection should always be excluded in transplant patients with hepatic dysfunction.

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