M Mihalcea-Danciu1, B Ellero2, M Gandoin3, M-L Harlay4, F Schneider4, P Bilbault3. 1. Service des urgences médico-chirurgicales adultes, hôpital de Hautepierre, CHU, 1, avenue de Molière, 67098 Strasbourg cedex, France. Electronic address: mihalcea78@yahoo.com. 2. Service de transplantation hépatique, hôpital de Hautepierre, CHU, 1, avenue de Molière, 67098 Strasbourg cedex, France. 3. Service des urgences médico-chirurgicales adultes, hôpital de Hautepierre, CHU, 1, avenue de Molière, 67098 Strasbourg cedex, France. 4. Service de réanimation médicale, hôpital de Hautepierre, CHU, 1, avenue de Molière, 67098 Strasbourg cedex, France.
Abstract
INTRODUCTION: 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. OBSERVATION: 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. CONCLUSION: 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.
INTRODUCTION: 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. OBSERVATION: 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. CONCLUSION: 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.