Fatal fulminant herpes simplex hepatitis following surgery in an adult

World Journal of Clinical Cases
Yoshihiro YokoiYoichi Watahiki

Abstract

We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus (HSV) type-1. The serum tests (available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.

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Citations

Sep 6, 2020·Reviews in Endocrine & Metabolic Disorders·Yanduan LinJiao Guo
Oct 9, 2020·The American Journal of Forensic Medicine and Pathology·Randall Bissessar, Rajesh P Kannan

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Methods Mentioned

BETA
biopsy
PCR
biopsies

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