Herpes simplex virus hepatitis - it's high time we consider empiric treatment.

Fulminant hepatitis is an uncommon complication of herpes simplex virus infection. Patients at risk, in particular pregnant women and immunosuppressed patients presenting with fulminant liver failure, receiving delayed acyclovir intervention may lose significant liver parenchyma prompting the need for liver transplantation. The diagnosis is often not straight forward due to the lack of specific signs or symptoms, while many patients are diagnosed at autopsy. Although herpes simplex virus associated fulminant hepatic failure carries a high mortality risk, early intervention with acyclovir may prove to be life saving. In fact, acyclovir given in the early stages of fulminant hepatic failure may prevent mortality and avoid the need for liver transplantation. We report here two pregnant women with fulminant herpes simplex virus hepatitis in whom a difference of a few hours in the initiation of empirical treatment made a vast difference to their hospital stay. The above results demonstrate a significant impact to fulminant hepatic failure and should prompt clinicians to consider empiric acyclovir therapy for at risk patients.