Herpes simplex virus hepatitis: An analysis of the published literature and institutional cases

✍ Scribed by John P. Norvell; Andres T. Blei; Borko D. Jovanovic; Josh Levitsky

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 98 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21250

✦ Synopsis

Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovirtreated patients as compared to 88% in the untreated subjects (P ϭ 0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age Ͼ40 yr, immunocompromised state, ALT Ͼ5,000 U/L, platelet count Ͻ75 ϫ 10 3 /L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.