valacyclovir and Liver-Failure--Acute

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