acyclovir and Hepatitis--Viral--Human

Herpes simplex virus (HSV) hepatitis is an uncommon cause of liver failure, but may have a dramatic outcome. We herein present a case report of a liver graft infection by HSV-1 associated with liver failure and encephalitis. A complete hospital chart review of the case and a literature search were undertaken. Literature review suggests that herpes simplex acute liver failure is rare and associated with a poor prognosis, even with early treatment. Novel diagnostic and preventive approaches need to be instituted.

Topics: Acyclovir; Antiviral Agents; Encephalitis, Herpes Simplex; Fatal Outcome; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 1, Human; Humans; Liver Failure, Acute; Liver Transplantation; Male; Middle Aged; Transplants

We report the case of a 35-y-old HIV-infected female, who presented fulminant varicella hepatitis and recovered under medical treatment. Varicella zoster virus is an uncommon cause of acute liver disease which occurs mainly in immunocompromised patients. Acyclovir is the cornerstone of the treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpesvirus 3, Human; HIV Infections; Humans

Fulminant hepatic dysfunction in the third trimester of pregnancy accompanied by fever may result from disseminated herpes simplex virus. Since 1969, 24 cases of herpes simplex hepatitis, including the current case, have been reported. Mucocutaneous lesions are present in only half of cases; therefore, suspicion for diagnosis of this disease is low. Twenty-five percent of cases were not diagnosed until autopsy. Maternal and perinatal mortality are high, approaching 39 percent for both mother and fetus. Early recognition with initiation of antiviral therapy appears to be most important in maximizing survival.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Pregnancy; Pregnancy Complications, Infectious

Hepatitis due to herpes simplex virus (HSV) is unusual in healthy individuals. To date, only 56 cases of HSV hepatitis in adult patients have been reported, including 21 pregnant patients. We describe a 25-year-old white woman in her 30th week of gestation who had progressive acute hepatitis. Histologic examination of the liver biopsy specimen showed diffuse microabscesses involving more than 50% of the hepatic parenchyma, with multiple hepatocytes containing Cowdry type A and ground-glass nuclear inclusions. The diagnosis of herpes hepatitis was confirmed by positive immunoreactivity to HSV antibodies in the tissue sections. Intravenous acyclovir therapy was immediately initiated, and the patient's condition improved dramatically. She then had a normal baby at term. Subsequently, the patient had a second pregnancy and an uncomplicated vaginal delivery without recurrence of the disease. Even though alterations of the humoral and cell-mediated immunity occur during pregnancy, herpes hepatitis is rare in pregnant women. Since the prompt administration of antiviral drugs is a lifesaving measure, we recommend including HSV hepatitis in the differential diagnosis of acute hepatitis in pregnancy.

Topics: Acute Disease; Acyclovir; Adult; Antibodies, Viral; Antibody Formation; Antiviral Agents; Biopsy; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunity, Cellular; Injections, Intravenous; Liver Abscess; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Simplexvirus

Topics: Acyclovir; Chronic Disease; Hepatitis, Viral, Human; Humans; Nucleosides; Ribavirin; Vidarabine

Two cases of herpes simplex virus hepatitis in pregnancy are presented. Each case was characterized by extremely high serum aminotransferase levels with minimal bilirubin elevation. In both cases, liver biopsy was instrumental in arriving at the diagnosis. In addition, computed tomography showed a radiographic appearance of the liver not characteristically seen in other hepatic disorders of pregnancy. A high index of suspicion in the second case led to early recognition and treatment. Despite the presence of fulminant liver failure and evidence of herpes encephalitis in the other case, institution of therapy with acyclovir was associated with complete recovery in both patients. The present cases are compared and contrasted with the literature. The incidence of two cases within a 6-month period suggests that herpes simplex virus hepatitis in pregnancy may occur more frequently than previously reported.

Topics: Acyclovir; Adult; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Pregnancy; Pregnancy Complications, Infectious

Topics: Acyclovir; Adrenal Cortex Hormones; Hepatitis B; Hepatitis C; Hepatitis, Chronic; Hepatitis, Viral, Human; Humans; Interferons; Ribavirin

A young, previously healthy woman developed bilateral exudative tonsillitis that was associated with severe systemic symptoms. This was followed by evidence of multisystem disease with acute abdominal pain, raised liver enzyme levels, respiratory difficulty, increasing drowsiness and multiple vesicular skin lesions. Herpes simplex virus type-1 was isolated from skin lesions and a throat swab and herpes simplex virus type-1 antigen was detected in a liver biopsy sample. She recovered rapidly without any sequelae after treatment with intravenously administered acyclovir.

Topics: Abdominal Pain; Acyclovir; Adult; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immune Tolerance

Topics: Acyclovir; Autonomic Nervous System Diseases; Encephalitis; Esophagitis; Facial Dermatoses; Female; Fingers; Hepatitis, Viral, Human; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant, Newborn; Keratitis, Dendritic; Male; Peripheral Nervous System Diseases; Recurrence; Respiratory Tract Infections; Stomatitis, Herpetic; Vaccination; Viral Vaccines

Topics: Acyclovir; Adolescent; Adult; Aged; Antibodies, Viral; Diagnosis, Differential; Hepatitis, Viral, Human; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Infectious Mononucleosis; Liver; Middle Aged; Pharyngitis

Of 786 children and adolescents enrolled in a multicenter trial of acyclovir for chickenpox, 27 (3.4%) met the case definition of varicella-zoster virus (VZV) hepatitis (serum aspartate aminotransferase level > or = 100 U/l). The clinical and cutaneous manifestations of chickenpox in the 15 placebo recipients with this complication did not differ significantly from those in 45 matched controls (p > 0.05), indicating that liver involvement by VZV is not a consequence of more extensive disease. Although acyclovir modified the course of chickenpox overall, it did not prevent VZV hepatitis; that is, the proportions of affected subjects with liver involvement postenrollment did not differ significantly between the drug and placebo recipients (50% vs 80%, p > 0.05). Serum aspartate aminotransferase levels that were elevated on day 4 postenrollment had returned to normal (< or = 60 U/l) by day 28 in 88% of the placebo group and in 83% of the drug-treated group. With 2 exceptions, all values were normal by 88 days postenrollment. We conclude that chemically defined VZV hepatitis is an infrequent, self-limiting complication of chickenpox in otherwise healthy children and adolescents.

Topics: Acyclovir; Adolescent; Antiviral Agents; Aspartate Aminotransferases; Case-Control Studies; Chi-Square Distribution; Chickenpox; Child; Child, Preschool; Double-Blind Method; Hepatitis, Viral, Human; Herpesvirus 3, Human; Humans; Incidence; Mississippi; Statistics, Nonparametric

Seventy-three immunocompromised patients with disseminated herpes zoster were evaluated in a double-blind controlled trial of acyclovir (n = 37) versus vidarabine (n = 36) therapy. Acyclovir was administered at 30 mg/kg/day at 8-h intervals and vidarabine was given as a continuous 12-h infusion at 10 mg/kg/day for 7 days (longer if resolution of cutaneous or visceral disease was incomplete). No demographic differences existed between treatment groups. No deaths attributable to varicella-zoster virus infection occurred within 1 month of treatment. Neither rates of cutaneous healing, resolution of acute neuritis, and frequency of postherpetic neuralgia nor adverse clinical and laboratory events differed between treatment groups. Acyclovir recipients were discharged from the hospital more promptly than vidarabine recipients (P = .04, log rank test). These data indicate that disseminated herpes zoster is amenable to therapy with either acyclovir or vidarabine; resultant mortality is low.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Child; Cost-Benefit Analysis; Double-Blind Method; Female; Hepatitis, Viral, Human; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Meningoencephalitis; Middle Aged; Neuritis; Pneumonia, Viral; Skin Diseases, Infectious; Vidarabine

The incidence of acute liver failure from herpes simplex virus is rare.. A 71-year-old Japanese man was diagnosed with acute liver failure and was transferred to our hospital. Steroid therapy, plasma exchange, and hemodiafiltration were started for liver failure, and antimicrobial therapy was initiated for pneumonia. Staphylococcus epidermidis was detected in blood culture. Skin rash appeared; a positive anti-herpes simplex virus result led to the diagnosis of acute liver failure from herpes simplex virus. Hence, acyclovir was started. After blood tests improved, treatments for acute liver failure were discontinued. Antimicrobial therapy was continued; however, he died. In this case, persistent bacteremia and drug-induced liver damage due to acyclovir may have contributed to his death.. Acute liver failure can lead to complications and death. Thus, careful observation is crucial, even if the patient has shown some improvements.

Topics: Acyclovir; Aged; Antiviral Agents; Hepatitis, Viral, Human; Herpes Simplex; Humans; Liver Failure, Acute; Male

BACKGROUND Herpes simplex virus-2 (HSV-2) affects nearly 1 in 5 adults in the United States. Complications such as viral hepatitis and dissemination are rare in immunocompetent hosts. In this report, we describe a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent patient with recurrent fevers and elevated aminotransferases. CASE REPORT A 57-year-old man with a history of type 2 diabetes and hypertension was admitted with a right index finger lesion concerning for an abscess. He underwent successful incision and drainage and was started on ampicillin-sulbactam. On Day 2 of hospitalization, he developed recurrent fevers and elevated aminotransferases and inflammatory markers. An extensive infectious, rheumatologic, and malignancy workup were pursued without immediate findings. Imaging demonstrated cirrhotic morphology of the liver and splenomegaly, but lab markers were intact for liver synthetic function. On Day 7 of hospitalization, fever frequency decreased, and HSV-2 titers resulted, with positive IgM and negative IgG. He subsequently developed erythematous, raised lesions in multiple dermatomes. Nucleic acid amplification testing of biopsied lesions was positive for HSV-2, confirming viral hepatitis secondary to disseminated HSV-2. He was started on intravenous acyclovir and discharged on valacyclovir following improvement in symptoms. CONCLUSIONS We report a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent host. Up to 25% of cases occur in immunocompetent hosts and many patients do not develop characteristic skin lesions. Early diagnosis and treatment of viral hepatitis secondary to disseminated HSV remains vital to minimize morbidity and mortality.

Topics: Acyclovir; Adult; Antiviral Agents; Diabetes Mellitus, Type 2; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Middle Aged

Herpes simplex virus (HSV) causes only 2-4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis.. A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion.. Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.

Topics: Acyclovir; Adult; Antiviral Agents; Cesarean Section; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Simplexvirus

Non-alphabetical hepatitis (Epstein Barr virus -EBV-, cytomegalovirus -CMV-, Herpes simplex virus -HSV-, varicella zoster virus -VZV-etc.) may be a mode of revelation of several underlying chronic liver diseases including autoimmune hepatitis (HAI). We report a peculiar case of acute EBV hepatitis, revealing type I autoimmune hepatitis confirmed by liver biopsy through puncture in a female patient on breast cancer treatment. The study involved a 29-year-old female patient on breast cancer treatment scheduled to receive radiotherapy and chemotherapy, hospitalized for acute severe hepatitis (fever with jaundice, hypertransaminasemia (normal AST level 47 and normal ALT level 23 and prothrombin activity 25%). The test for viral hepatitis A, B, C, and E was negative and subhepatic veins were free on doppler. Non-alphabetical hepatitis was suspected based on fever with jaundice. Patient's assessment showed recent EBV infection diagnosed on the basis of the presence of anti-VAC IgM/G and anti-EBNA Ab IgG. The patient received acyclovir for 10 days. Progression was marked by ascites. The diagnosis of autoimmune hepatitis was retained based on laboratory tests (gamma peak on serum protein electrophoresis and positive anti-nuclear antibodies) and histological examination. Clinical-biological remission was obtained with corticosteroid therapy. EBV infections should be investigated in immunocompromised patients with fever in the clinical course of acute hepatitis. Practitioners should also suspect it in patients with persistent cytolysis following an infectious episode in order to prevent the occurrence of autoimmune hepatitis, in particular in female patients, in a context of self-immunity and negative serological tests for alphabetical viral hepatitis.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Ascites; Breast Neoplasms; Disease Progression; Epstein-Barr Virus Infections; Female; Glucocorticoids; Hepatitis, Autoimmune; Hepatitis, Viral, Human; Humans; Severity of Illness Index

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunoglobulin G; Laparoscopy; Valacyclovir

The unexpected transmission of donor-derived infection through organ transplantation is a rare event with current donor screening practices. In this case report we describe a probable donor-derived transmission of Herpes Simplex Virus (HSV)-2 via deceased donor kidney transplantation resulting in HSV hepatitis in the recipient. This manifested as acute liver failure which resolved with appropriate anti-viral therapy. Following recovery from the acute liver insult, the patient developed fibrotic liver morphology and portal hypertension, an unusual departure from the typical course.

Topics: Acyclovir; Adult; Allografts; Antiviral Agents; Biopsy; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Hypertension, Portal; Kidney; Kidney Transplantation; Liver; Liver Cirrhosis; Liver Failure, Acute; Treatment Outcome

We present the case of a patient, with history of myelodysplastic syndrome and recent bone marrow transplant, who developed fulminant liver failure secondary to herpes simplex virus (HSV) hepatitis. His presentation was unique, as findings of liver microabscesses on computed tomography scan have not been described previously in this patient population. Despite initial treatment with acyclovir, he continued to deteriorate, and later sensitivities found the HSV strain to be resistant to acyclovir. HSV hepatitis with secondary liver failure is rare and, without appropriate treatment, its mortality is >80%. Early suspicion and immediate therapy are the keys to improve patient survival.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Bone Marrow Transplantation; Drug Resistance, Viral; Fatal Outcome; Foscarnet; Graft vs Host Disease; Hepatitis, Viral, Human; Humans; Liver; Liver Failure, Acute; Male; Middle Aged; Myelodysplastic Syndromes; Patient Comfort; Polymerase Chain Reaction; Simplexvirus; Transaminases; Transplantation, Homologous; Valacyclovir; Valine

Liver failure is a frequent and serious complication that causes morbidity and mortality in haematopoietic stem cell transplantation (HCT) recipients. Liver dysfunction in these patients can be related to infectious causes, most common viral hepatitis. We report a case of disseminated acyclovir-resistant herpes simplex virus (HSV) infection following HCT that led to acute liver failure and death. Although rare, HSV hepatitis leads to high morbidity and mortality and should be considered in the differential diagnosis of HCT recipients with marked elevation of hepatic transaminase. Acyclovir is a first-line therapy for HSV infection; however, acyclovir-resistant viral strains should be considered and alternative HSV therapies given in HCT recipients whose HSV infection does not improve on acyclovir therapy.

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Drug Resistance, Viral; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Liver Failure, Acute; Male; Middle Aged; Tomography, X-Ray Computed; Valacyclovir; Valine

We here report the case of a 52-year old man who presented hepatitis with hemophagocytic syndrome triggered by herpes simplex 1 (HSV-1) primary infection. A high-level viremia was observed, and HSV-1 DNA remained detectable in blood for a long time after patient's recovery.

Topics: Acyclovir; DNA, Viral; Etoposide; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunoglobulins, Intravenous; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Treatment Outcome; Viral Load

Herpes simplex virus (HSV) hepatitis is a rare and serious complication in immunocompromised patients. We report the case of an HSV hepatitis occurring 4 years after lung transplantation in a cystic fibrosis patient. The presentation was nonspecific, mimicking acute cholecystitis; orogenital signs were absent. The diagnosis was made based on viral cultures performed during cholecystectomy and confirmed by blood quantitative polymerase chain reaction. Although the diagnosis and treatment were delayed, the patient fully recovered with acyclovir, reduced immunosuppression, and intravenous immunoglobulins. The diagnostic difficulties, prognostic factors, and treatments of this infection are discussed.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpesvirus 2, Human; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Lung Transplantation

Topics: Acyclovir; Adult; Alanine Transaminase; Aspartate Aminotransferases; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Kaposi Varicelliform Eruption; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Antiviral Agents; Biopsy; Cesarean Section; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Liver; Pregnancy; Pregnancy Complications; Simplexvirus; Treatment Outcome; Young Adult

A young woman presented with a febrile illness in the third trimester of pregnancy. Laboratory investigation revealed severe acute hepatitis with thrombocytopenia and coagulopathy. Liver injury progressed despite emergent caesarian section and delivery of a healthy infant. Therefore, therapeutic plasma exchange (TPE) was performed on three consecutive days post-partum for a presumed diagnosis of acute liver failure (ALF) associated with pregnancy due to hemolysis, elevated liver enzymes, and low platelets (HELLP) or acute fatty liver of pregnancy (AFLP). Treatment with TPE was followed by biochemical and clinical improvement but during her recovery herpes simplex virus type 2 (HSV-2) infection was diagnosed serologically and confirmed histologically. Changes in the immune system during pregnancy make pregnant patients more susceptible to acute HSV hepatitis, HSV-related ALF, and death. The disease is characterized by massive hepatic inflammation with hepatocyte necrosis, mediated by both direct viral cytotoxicity and the innate humoral immune response. TPE may have a therapeutic role in acute inflammatory disorders such as HSV hepatitis by reducing viral load and attenuating systemic inflammation and liver cell injury. Further investigation is needed to clarify this potential effect. The roles of vigilance, clinical suspicion, and currently accepted therapies are emphasized.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Cesarean Section; Combined Modality Therapy; Dexamethasone; Emergencies; Female; Fetal Organ Maturity; Hepatitis, Viral, Human; Herpes Simplex; Humans; Hydrocortisone; Infant, Newborn; Liver Failure; Male; Plasma Exchange; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Puerperal Disorders; Systemic Inflammatory Response Syndrome; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Diagnosis, Differential; Female; Fever; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompromised Host; Infusions, Intravenous; Neutropenia; Recurrence; Risk; Transaminases

Herpes simplex virus (HSV)-induced sepsis affects immunocompromised patients. We report here the case of an immunocompetent adult with sepsis, hepatitis, renal failure and esophagitis. The possibility of HSV should be considered in cases of sepsis without any evident cause, even in immunocompetent patients. The characteristic endoscopic and histological findings of the associated esophagitis may assist the etiology of sepsis.

Topics: Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompetence; Male; Middle Aged; Sepsis; Ulcer

Acute gestational hepatitis from herpes simplex virus (HSV) infection is a rare but potentially life-threatening condition. We present the first reported case of primary HSV type 2 hepatitis in a pregnant woman who was diagnosed by detection of HSV-2 viremia via real-time polymerase chain reaction. The patient was successfully treated with acyclovir and delivered a healthy infant.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Valacyclovir; Valine

Fulminant hepatic failure (FHF) is a rare but well-recognized complication of primary herpes simplex virus (HSV) infection in immunocompromised patients. Here, we report two cases of acute hepatitis and FHF secondary to primary HSV type 1 infection following renal transplantation in the absence of any mucocutaneous manifestation. High levels of HSV type-1 DNA were detected in the blood. Both patients were seronegative for HSV 1 and HSV 2 immunoglobulin G (IgG) before transplantation, whereas the donor of patient 1 was HSV 1 IgG-positive but had no viremia and the donor of patient 2 was HSV-seronegative. Patient 1 recovered with acyclovir and immunoglobulin whereas patient 2 did not respond and succumbed to death. HSV-seronegative patients are potentially at risk of developing severe primary HSV disease following transplantation, particularly in the absence of routine anti-viral prophylaxis. HSV infection should always be excluded in transplant patients with hepatic dysfunction.

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Fatal Outcome; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Transplantation; Liver Failure, Acute; Male; Middle Aged; RNA, Viral; Tomography, X-Ray Computed; Treatment Outcome

Fulminant hepatitis is an uncommon complication of herpes simplex virus infection. Patients at risk, in particular pregnant women and immunosuppressed patients presenting with fulminant liver failure, receiving delayed acyclovir intervention may lose significant liver parenchyma prompting the need for liver transplantation. The diagnosis is often not straight forward due to the lack of specific signs or symptoms, while many patients are diagnosed at autopsy. Although herpes simplex virus associated fulminant hepatic failure carries a high mortality risk, early intervention with acyclovir may prove to be life saving. In fact, acyclovir given in the early stages of fulminant hepatic failure may prevent mortality and avoid the need for liver transplantation. We report here two pregnant women with fulminant herpes simplex virus hepatitis in whom a difference of a few hours in the initiation of empirical treatment made a vast difference to their hospital stay. The above results demonstrate a significant impact to fulminant hepatic failure and should prompt clinicians to consider empiric acyclovir therapy for at risk patients.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Pregnancy; Pregnancy Complications, Infectious

Herpes simplex virus (HSV) hepatitis has a fatal impact on the outcome of organ transplanted recipients. Here, we present a thought-provoking case of HSV hepatitis in a high-risk recipient after living-related liver transplantation (LRLT). A 1-month-old female newborn infant was affected by HSV encephalitis. Fulminant hepatic failure (FHF) of unknown etiology occurred suddenly at 4.4 years of age. Viral infections were ruled out as the cause of FHF. Intensive care including plasma exchange (PE) was started, and the preoperative treatments for ABO incompatibility were performed. Thereafter, LRLT was performed emergently. Although strong immunosuppression for ABO incompatibility was continued after LRLT, antibody-mediated rejection (AMR) occurred on postoperative day (POD) 4. PE was repeated and improvements were obtained. However, liver dysfunction appeared on POD 8. Histopathological findings of liver needle biopsy clearly revealed HSV hepatitis, although the results of HSV DNA and antibody titer in blood sample did not clearly indicate HSV infection. On POD 21, thrombotic microangiopathy (TMA) occurred and the plasma and immunoglobulin were replenished. Our pediatric recipient recovered successfully from AMR, HSV hepatitis, TMA, and repeated sepsis. We conclude that well considered therapy based on the real-time detection of HSV hepatitis is indispensable for the further improvements of outcome in HSV hepatitis after LRLT.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Encephalitis, Herpes Simplex; Female; Hepatitis, Viral, Human; Humans; Liver Failure, Acute; Liver Transplantation; Simplexvirus

Herpes simplex virus hepatitis is a rare but potentially fatal condition that usually affects the immunocompromised, including pregnant women. This case report details the course of fulminant hepatic failure in a woman at 31 weeks gestation resulting in emergent delivery of the fetus and liver transplant in the mother.

Topics: Acyclovir; Adult; Antiviral Agents; Cardiotocography; Cesarean Section; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesviridae Infections; Herpesvirus 2, Human; Humans; Infant, Newborn; Liver Failure, Acute; Liver Transplantation; Male; Pregnancy; Pregnancy Complications, Infectious

A 42-year-old woman was referred with fever and abdominal pain with peritoneal irritation. A diagnostic laparoscopy showed hepatic lesions. Histopathological investigation of the liver biopsy showed hepatitis caused by herpes simplex virus (HSV). The patient was treated with acyclovir and recovered well. HSV is a rare cause of viral hepatitis and has a high mortality rate.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompetence; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Biopsy; Hepatitis, Viral, Human; Herpes Simplex; Humans; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiography; Treatment Outcome

Topics: Abnormalities, Multiple; Acute Disease; Acyclovir; Antiviral Agents; Drug Therapy, Combination; False Negative Reactions; Female; Hepatitis, Viral, Human; Humans; Immunohistochemistry; Injections, Intravenous; Kidney Transplantation; Liver; Polymerase Chain Reaction; Simplexvirus; Syndrome; Urogenital Abnormalities; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy, Needle; Female; Foscarnet; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Kidney Transplantation; Liver; Liver Transplantation; Pancreas Transplantation; Transplantation, Homologous; Treatment Outcome

Topics: Acyclovir; Anemia, Hemolytic, Autoimmune; Anti-Inflammatory Agents; Antiviral Agents; Chickenpox; Heart Failure; Hepatitis, Viral, Human; Hepatomegaly; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infant; Male; Methylprednisolone; Prednisolone; Splenomegaly

We report an immunocompetent woman with multisystem organ failure following herpes simplex virus type 2 (HSV-2) hepatitis. After she initially responded to intravenous acyclovir, she was switched to oral valacyclovir. She developed respiratory failure and opportunistic infections and died. Autopsy confirmed disseminated HSV infection, and lung tissue grew acyclovir-resistant HSV-2.

Topics: Abdominal Pain; Acyclovir; Adult; Drug Resistance, Viral; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunocompetence; Treatment Failure

Herpes simplex virus (HSV) infection can affect various organs-systems in the neonatal period. Herpetic hepatitis was seldom reported in the literature. We report on 2 cases. Firstly, a 16 day-old newborn infant was admitted because of haemorrhagic syndrome and shock. Biological assessment showed a severe hepatic insufficiency. Antibiotic and aciclovir therapy was started as HSV infection was suspected. Five days later, the herpetic attack was confirmed by polymerase chain reaction (PCR) in blood and cerebrospinal fluid (CSF). The genotye of the virus in the CSF was HSV1. Treatment included aciclovir for 21 days intravenously and 2 months orally. At 10 months, the clinical and biological examinations were normal. Secondly, a 4 day-old newborn was hospitalised because of fever and polypnea. Pulmonary X rays showed heterogeneous opacities of the right base. Serum C reactive protein was 30 mg/l. Antibiotic therapy was started. Two days later, the fever persisted while a severe hepatic insufficiency developed. The diagnosis of herpetic hepatitis was evoked and the child was given aciclovir. Forty-eight hours later, the PCR confirmed a HSV in blood, while viral culture of a mouth swab found HSV 2. Evolution was favourable after 21 days of specific and symptomatic treatment. Aciclovir treatment was continued orally for six months. Herpetic hepatitis is rare in the neonatal period. Diagnosis must be evoked early when facing severe neonatal hepatic insufficiency. Provided specific treatment, prognosis is good.

Topics: Acyclovir; Antiviral Agents; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Prognosis; Simplexvirus

Herpes simplex virus (HSV) hepatitis in pregnant women is a rare condition. We report a case confirmed by liver biopsy and successfully treated with empiric intravenous acyclovir.. A 25-year-old primigravida at 34 weeks of gestation presented with fever, thrombocytopenia, and markedly elevated liver enzymes. The patient was treated empirically and was delivered by cesarean. After delivery failed to correct her condition, a liver biopsy revealed HSV hepatitis. The fetus was unaffected and the patient recovered with an extended course of acyclovir.. Pregnant women are susceptible to disseminated HSV causing hepatitis. A high index of suspicion is necessary to diagnose HSV hepatitis and begin appropriate treatment with acyclovir. Herpes simplex virus hepatitis should be included in the differential diagnosis for liver failure during pregnancy.

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Cesarean Section; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Liver; Liver Failure; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Simplexvirus; Thrombocytopenia

Immunosuppressive agents (azathioprine, methotrexate) are increasingly being used in the treatment of inflammatory bowel disease. The use of immunosuppressive agents is associated with a greater risk of opportunistic infections, the most frequent of which are those caused by cytomegalovirus and varicella zoster virus. We present four cases of opportunistic infections due to Herpesviruses in patients undergoing immunosuppressive treatment with azathioprine for Crohn's disease. We also review the literature published on this topic. Two patients presented cutaneous varicella complicated by pneumonia and esophagitis respectively, one patient had cutaneous herpes zoster and the other had fatal pneumonia possibly caused by the Herpesvirus. In the first three the clinical course of the infection was favorable after withdrawing immunosuppressant treatment and initiating treatment with aziclovir. In patients Crohn's disease azathioprine treatment increases the risk of opportunistic infection by Herpesvirus. However, in the absence of other factors that increase immunosuppression, these infections usually have a benign course with specific antiviral therapy.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Azathioprine; Chickenpox; Crohn Disease; Disease Susceptibility; Esophageal Diseases; Fatal Outcome; Female; Ganciclovir; Hepatitis, Viral, Human; Herpes Zoster; Herpesviridae Infections; Humans; Immunosuppressive Agents; Leukopenia; Lymphopenia; Male; Opportunistic Infections; Pneumonia, Viral

Topics: Acyclovir; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Liver Failure; Liver Transplantation; Pregnancy

The impact of cytomegalovirus (CMV) infection post-transplantation is in part influenced by the degree of immunosuppression. While mycophenolate mofetil (MMF) does not increase the overall incidence of CMV infection, we have questioned whether or not it increases its severity. Using a case control study design in which 29 renal transplant patients developed CMV disease [17 (59%) of which received azathioprine (AZA) and 12 (41%) received MMF], increases in the frequency of organ involvement with CMV (58 vs. 18%; p = 0.03) and in the number of organs involved with CMV were noted in the MMF versus the AZA group (2.0 vs. 1.0; p = 0.015). These results indicate that the increased immunosuppressive activity of MMF impacts the morbidity of CMV infection, thus warranting the use of effective anti-CMV preventive regimens while patients are treated with MMF.

Topics: Acyclovir; Adult; Antiviral Agents; Azathioprine; Case-Control Studies; Cohort Studies; Cytomegalovirus Infections; Enteritis; Female; Ganciclovir; Hepatitis, Viral, Human; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Mycophenolic Acid; Pneumonia, Viral; Risk Factors; Severity of Illness Index

Two apparently immunocompetent adult patients developed acute fulminant hepatitis during presumptive primary herpes simplex virus type 1 (HSV-1) infection without any visible mucocutaneous lesions. HSV hepatitis was not suspected in the case of patient 1, who died without treatment. Patient 2 was empirically treated with acyclovir because of the triad of high fever, leukopenia, and markedly elevated levels of aminotransferases, and this patient survived. Most immunocompetent patients with fulminant HSV hepatitis do not have visible mucocutaneous ulcers, and HSV is frequently not considered as a cause of acute hepatitis. In summary, fulminant hepatitis can occur during HSV infections, the diagnosis is frequently missed or delayed because of the absence of mucocutaneous ulcerations, and patients who receive early empirical treatment with acyclovir can survive this illness.

Topics: Acyclovir; Hepatitis, Viral, Human; Herpes Simplex; Humans; Male; Middle Aged

Topics: Acyclovir; Adult; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Pregnancy; Pregnancy Complications, Infectious

Varicella (chicken pox) is a common viral infection in children and generally runs a benign course. However, in adults, and especially in immunocompromised subjects such as those on immunosuppressant therapy or with AIDS, varicella infection is particularly severe and is associated with the formation of hemorrhagic skin lesions and visceral involvement. These patients are at an increased risk of developing varicella hepatitis, which frequently results in fulminant hepatic failure and death. In the present report, we describe for the first time the course of disease and the histological appearance of varicella hepatitis in a patient infected with the human T cell lymphotropic viruses (HTLV) I and II; these viruses have many characteristics in common with the human immunodeficiency virus (HIV). Our patient had a relatively benign illness, suggesting that varicella infection in the presence of HTLVI and II may not run as severe a course as it does in patients with HIV infection.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Hepatitis, Viral, Human; HTLV-I Antibodies; HTLV-I Infections; HTLV-II Antibodies; HTLV-II Infections; Humans; Liver Function Tests; Male; Middle Aged

Herpes simplex virus (HSV) may cause severe disease in the neonate with high mortality and devastating sequellae. This infection presents exceptionally as isolated fulminant hepatitis.. An 8 day-old baby was admitted because of seizures, fever and vomiting. Initial investigations including CSF analysis were negative and the patient was given ampicillin plus netilmicin. Two skin vesicles were seen 5 days later containing HSV. A second CSF analysis was negative as was the brain scan. At that time, liver involvement was evident: ASAT 3700 IU/l; ALAT 1035 IU/l; prothrombin 37%; fibrinogen 1 g/l. Hemogram showed WBC: 2,500/mm3 and PNN: 702/mm3. The patient was given acyclovir 40 mg/kg/day IV. Blood and CSF culture remained negative; CSF interferon concentration was 4 IU/ml. Serologic investigations in both parents were inconclusive. The disease worsened rapidly with consumption coagulopathy requiring ventilation support. The dose of acyclovir was increased to 60 mg/kg/day, 9 days after admission. Improvement was noted on the 10th day and acyclovir was administered orally on the 21st day. The condition was completely normal 6 months later.. Early administration of acyclovir may favor complete recovery of neonatal HSV hepatitis.

Topics: Acyclovir; Administration, Oral; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infant, Newborn; Injections, Intravenous; Male

Topics: Acyclovir; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Pregnancy; Pregnancy Complications, Infectious

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Hepatitis, Viral, Human; Herpes Simplex; Humans; Male

A healthy 20-year-old woman developed herpes simplex virus (HSV) hepatitis. The diagnosis was made by needle biopsy of the liver, and the patient was intravenously treated with acyclovir for 15 consecutive days (total dose, 21 g). The liver biopsy specimen and liver tissue obtained at autopsy were processed for immunoperoxidase staining with rabbit anti-HSV and for DNA-DNA in situ hybridization. The liver biopsy tissue revealed massive necrosis of hepatocytes, which were strongly positive for HSV with both immunoperoxidase and in situ hybridization methods. The liver tissue obtained at autopsy showed regenerative nodules of hepatocytes, surrounded by connective tissue stroma. Within the connective tissue there were completely necrotic hepatocytes, which were positive for HSV with the immunoperoxidase method but almost completely negative with the in situ hybridization method, except for a very few HSV DNA-positive hepatocytic nuclei. It was concluded that immunoperoxidase staining with anti-HSV is a sensitive method with which to detect ongoing and previous HSV infection, whereas the in situ hybridization method is specific for HSV-DNA from viable HSV.

Topics: Acyclovir; Adult; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunoenzyme Techniques; Nucleic Acid Hybridization; Simplexvirus

A 17-year-old male patient with T-cell type lymphoblastic lymphoma in complete remission underwent high dose chemotherapy (busulfan 16 mg/kg and cyclophosphamide 120 mg/kg) followed by autologous bone marrow transplantation (ABMT). The patient had been taking oral acyclovir (200 mg x 5) daily from seven days prior to the ABMT (day -7). On day +24, he complained of epigastralgia and general malaise, and the next day his GOT and GPT rose to 570 U/l and 397 U/l, respectively. Although he had no mucocutaneous lesions, hepatitis caused by a herpes virus was suspected, and high dose intravenous acyclovir (10 mg/kg x 3/day) was immediately started. His GOT, GPT and total bilirubin reached peaks of 2,870 U/l on day +26, 1,830 U/l on day +27 and 10.3 mg/dl on day +39, respectively, and rapidly improved thereafter. Serological analyses on IgG antibody titers to herpes simplex virus type 1 using an enzyme-linked immunosorbent assay revealed specific increases (454-fold before transplantation to 3,830-fold on day +46). Antiviral antibody titers to cytomegalovirus, varicella-zoster virus and Epstein-Barr virus showed no significant changes. The serologic markers of hepatitis B virus, hepatitis A virus and hepatitis C virus were all negative. The results indicate the patient's severe icteric hepatitis to have been caused by a reactivation of herpes simplex virus type 1 due to immunosuppression after high dose chemotherapy with ABMT. It is suggested that prompt commencement of high dose intravenous acyclovir is required to treat severe herpes simplex virus hepatitis affecting immunocompromised patients.

Topics: Acyclovir; Adolescent; Bone Marrow Transplantation; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infusions, Intravenous; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Transplantation, Autologous

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Female; Ganciclovir; Hepatitis, Viral, Human; Humans; Liver Transplantation; Male; Middle Aged; Opportunistic Infections; Retrospective Studies

Topics: Acyclovir; Chickenpox; Hepatitis, Viral, Human; Herpes Zoster; Humans; Kidney Transplantation

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Topics: Acute Disease; Acyclovir; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infant, Newborn; Male; Necrosis; Simplexvirus; Time Factors

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Cytomegalovirus; Female; Hepatitis, Viral, Human; Humans; Immunoglobulin M; Male; Treatment Outcome

Topics: Acyclovir; Azathioprine; Chronic Disease; Drug Evaluation; Drug Therapy, Combination; Hepatitis; Hepatitis, Chronic; Hepatitis, Viral, Human; Humans; Prednisone; Vidarabine

Primary varicella-zoster (VZ) infection in eight children with perinatally acquired human immunodeficiency virus infection tended to be severe, prolonged, complicated by bacterial infections and in one case fatal. Depletion of CD4-lymphocytes was associated with chronic and recurrent VZ infection. In some patients convalescent VZ antibody titers were low and did not correlate with recurrence of VZ lesions. Administration of acyclovir appeared to be beneficial in suppressing VZ in human immunodeficiency virus-infected children with primary or recurrent VZ infection.

Topics: Acyclovir; Bacterial Infections; Chickenpox; Child; Child, Preschool; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Infant; Male; Pneumonia, Viral; Recurrence

Herpes simplex virus (HSV) hepatitis in adults is a rare and severe disease usually occurring in immunocompromised patients or pregnant women. We report on a case of primary HSV type I hepatitis in a 48-year-old male renal transplant recipient with successful outcome after acyclovir treatment.

Topics: Acyclovir; Hepatitis, Viral, Human; Herpes Simplex; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications

Topics: Acyclovir; Adult; Colitis; Crohn Disease; Cytomegalovirus Infections; Female; Ganciclovir; Hepatitis, Viral, Human; Humans

Primary varicella-zoster virus infection (chickenpox) in immunocompromised children is frequently associated with visceral dissemination and attendant high mortality. Eight children with malignant neoplasms and chickenpox with visceral involvement (seven with hepatitis, three with pneumonitis, two with encephalitis, and two with coagulopathy) were initially treated with intravenously (IV) administered vidarabine but demonstrated progressive visceral involvement. After three days of vidarabine treatment (two days for two patients), seven had rising serum SGPT levels, all eight had pneumonitis, seven had deteriorating mental status and/or seizure activity, and six had worsening coagulopathy. Vidarabine was replaced by IV administered acyclovir, with subsequent improvement in all but the most severely ill patient who died. Seven of eight patients recovered completely; no side effects of acyclovir were observed. This clinical experience suggests that acyclovir may be more effective than vidarabine in disseminated varicella infection; however, controlled clinical trials will be necessary to establish this.

Topics: Acyclovir; Blood Coagulation Disorders; Chickenpox; Child; Encephalitis; Female; Hepatitis, Viral, Human; Humans; Leukemia, Lymphoid; Lymphatic Diseases; Male; Pneumonia, Viral; Vidarabine

Five patients with chronic non-A, non-B hepatitis were entered into a pilot therapeutic study of the antiviral agent acyclovir [9-(2-hydroxyethoxymethyl)guanine]. Each patient received acyclovir by slow intravenous infusion in a dosage of 5 mg/kg every 8 hr for 10 days. During therapy, serum aminotransferase levels decreased by more than 50% in two patients, remained unchanged in two patients, and rose (by 32%) in the final patient. The two patients whose serum aminotransferase levels decreased during acyclovir treatment subsequently received a second course of drug using a higher dose (10 mg/kg every 8 hr for 10 days). Serum aminotransferase levels rose in both patients (by 54% and 121%) during the second course of therapy. Acyclovir was well tolerated in these patients, and there were no symptoms or signs attributable to drug toxicity during or after treatment. During a subsequent 12-month follow-up period, none of the five patients has manifested either a clinical or serum biochemical improvement in their chronic liver disease. Spontaneous fluctuations in serum aminotransferase levels unrelated to acyclovir therapy were noted in three of the five patients. These findings suggest that a short course of acyclovir does not have any appreciable long-term beneficial effect on the course of chronic non-A, non-B hepatitis.

Topics: Acyclovir; Adult; Alanine Transaminase; Aspartate Aminotransferases; Chronic Disease; Drug Evaluation; Female; Hepatitis C; Hepatitis, Viral, Human; Humans; Male; Middle Aged; Pilot Projects