Herpes simplex virus hepatitis in immunocompetent sexually active patient: Case report

Abstract

Introduction: Herpes simplex virus (HSV) is a highly prevalent infection, which on rare occasions can become disseminated and be responsible for serious complications including significant neurological, gastrointestinal and even cardiac morbidity. This article presents a case of rare but yet potentially fatal complication of HSV which is hepatitis in an immunocompetent patient. Case. 22 years-old Caucasian female who presented to a peripheral hospital with fever and dysuria. She was admitted to a peripheral hospital and treated for presumptive diagnosis of urinary tract infection without any amelioration in symptoms after multiple days of antibiotics. Deterioration in clinical status triggered transfer to our institution, where further workup yielded the diagnosis of herpes hepatitis which was successfully treated with good patient outcome. Discussion: Hepatitis secondary to HSV is a rare diagnosis that can rapidly progress to fulminant liver failure. Early recognition and treatment within the first 72 h from onset are essential. Yet despite initiation of appropriate antiviral therapy, morbidity and mortality remain high. As a consequence, empiric antiviral therapy should be considered by providers for patients that have such characteristics as the latter ones or have history of HSV in order to avoid the possibly fatal outcomes. Conclusion: HSV hepatitis is difficult to diagnose, it carries a high mortality rate, thus emphasizing on the importance of early diagnosis and treatment to prevent the development of acute liver failure. It should be considered in the differential diagnosis of any case of severe hepatitis.