Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, USA.
J Gastrointestin Liver Dis. 2011 Mar;20(1):93-6.
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.
暴发性肝炎是单纯疱疹病毒感染的罕见并发症。有患病风险的患者，尤其是出现暴发性肝衰竭的孕妇和免疫抑制患者，如果接受阿昔洛韦治疗的时间延迟，可能会失去大量肝实质，从而需要进行肝移植。由于缺乏特定的体征或症状，该疾病的诊断通常并不简单，许多患者都是在尸检时才被确诊。虽然单纯疱疹病毒相关的暴发性肝衰竭的死亡率很高，但早期使用阿昔洛韦进行干预可能具有挽救生命的效果。事实上，在暴发性肝衰竭的早期阶段使用阿昔洛韦可能会降低死亡率，并避免进行肝移植。我们在此报告两例患有暴发性单纯疱疹病毒肝炎的孕妇，她们在开始经验性治疗的时间上相差数小时，这对她们的住院时间产生了巨大的影响。上述结果表明阿昔洛韦治疗对暴发性肝衰竭有显著影响，这应该促使临床医生考虑对有患病风险的患者进行经验性阿昔洛韦治疗。
