Abstract
Although herpes simplex virus (HSV) infection manifests with a range of symptoms, progression to fulminant hepatitis is rare. We describe herein our experience treating a patient with HSV that developed into fulminant hepatitis and virus-associated hemophagocytic syndrome (VAHS). The patient was a 26-year-old woman who initially presented to another hospital with chief complaints of fever and general malaise, and was immediately admitted based on a diagnosis of acute hepatitis. Hepatic dysfunction failed to improve, so she was then referred to our hospital and admitted to our Department of Gastroenterological Medicine for further care and was then transferred to the intensive care unit the following day for systemic care. Fulminant hepatitis, hemophagocytic syndrome (HPS), and disseminated intravascular coagulation were diagnosed based on the findings of physical examination and hematology on admission, and she was started on plasma exchange, high-dose steroid therapy, and immunosuppressive therapy. HSV was subsequently identified as the underlying cause based on the results of virus antibody testing and liver biopsy immunostaining, and antiviral drugs were added to the treatment regimen. The patient responded to treatment and was released from the ICU 13 days after admission. While fulminant HSV hepatitis is rare, delays in treatment can adversely impact patient prognosis. Early biopsy should therefore be considered in the event of fulminant hepatitis of HSV.
