Acute liver failure due to severe Herpes simplex viral hepatitis in an elderly woman: A case of initial infection

• Published in: Hepatology research Vol. 49; no. 7; pp. 830 - 835
• Main Authors: Suda, Tsuyoshi, Hodo, Yuji, Shirota, Yukihiro, Ogawa, Haruhiko, Sato, Katsuaki, Wakabayashi, Tokio
• Format: Journal Article
• Language: English
• Published: Netherlands Wiley Subscription Services, Inc 01.07.2019
• Subjects: acute liver failure; Asthma; Autopsy; Disseminated intravascular coagulation; elderly people; Geriatrics; Hepatitis; Hepatocytes; Herpes simplex; Herpes simplex viral hepatitis; Herpes viruses; Immunoglobulin G; Immunosuppressive agents; initial infection; Liver; Liver failure; Older people; Pharyngitis; Pharynx; Ribonucleic acid; RNA; Steroid hormones; Swallowing; initial infection; elderly people; acute liver failure; Herpes simplex viral hepatitis
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.13301

The high mortality rate due to severe Herpes simplex viral (HSV) hepatitis is associated with the difficulty of its diagnosis. We describe the extremely rapid disease course of a patient who died of severe HSV hepatitis. A 73‐year‐old woman was admitted for a bronchial asthma attack. Her symptoms improved with steroid treatment, but she developed a sore throat and painful swallowing. On day 12 after admission, she suddenly went into shock. Blood test results showed a significant increase in the liver enzyme levels, with remarkable disseminated intravascular coagulation. She died the same day. The autopsy revealed extensive coagulative necrosis of the liver. Viral inclusion of type A Cowdry bodies was found in the residual hepatocytes in the hepatic lobule. Immunostaining revealed HSV type 1 positivity. We diagnosed the cause of death as severe HSV hepatitis. On examination of a stored serum sample, the patient tested positive for the HSV immunoglobulin (Ig)‐M antibody, and the HSV RNA level was very high (1 × 109 copies/mL). Remarkably, the HSV IgG test result was negative, and we diagnosed her as having had an initial HSV infection. Hepatitis due to HSV is very rare in healthy adults; however, there are many reports of immune‐deficient cases. The presence of HSV IgG is decreasing in the elderly population because of the change in living environments/lifestyles. The increasing use of immunosuppressive drugs, such as steroids, for treating diseases in elderly patients could be linked to the increased prevalence of initial HSV infections, resulting in liver injury.