Mihalcea-Danciu M, Ellero B, Gandoin M, Harlay M-L, Schneider F, Bilbault P
Service des urgences médico-chirurgicales adultes, hôpital de Hautepierre, CHU, 1, avenue de Molière, 67098 Strasbourg cedex, France.
Service de transplantation hépatique, hôpital de Hautepierre, CHU, 1, avenue de Molière, 67098 Strasbourg cedex, France.
Rev Med Interne. 2014 Dec;35(12):823-6. doi: 10.1016/j.revmed.2013.07.009. Epub 2013 Aug 28.
Herpes simplex hepatitis is a rare cause of acute hepatitis in immunocompetent patients. The triad of fever, increase in liver enzymes and leucopenia is suggestive of herpes simplex hepatitis. Delayed diagnosis without antiviral therapy contributes significantly to an unfavorable outcome.
We report a 50-year old immunocompetent male patient, who presented with acute severe hepatitis due to a reactivation of a herpes simplex infection with a complicated course including macrophage activation syndrome and severe coagulopathy. Outcome was finally favorable with early acyclovir therapy.
Despite its relatively low occurrence rate, diagnosis of herpetic hepatitis should be discussed in immunocompetent patients with acute liver failure. The benefit of an early acyclovir treatment should lead clinicians to consider this uncommon diagnosis in unexplained cases of hepatitis and to test rapidly HSV DNA levels by PCR in plasma.
单纯疱疹病毒性肝炎是免疫功能正常患者急性肝炎的罕见病因。发热、肝酶升高和白细胞减少三联征提示单纯疱疹病毒性肝炎。未经抗病毒治疗的延迟诊断对不良预后有显著影响。
我们报告一例50岁免疫功能正常的男性患者，因单纯疱疹感染复发导致急性重症肝炎，病程复杂，包括巨噬细胞活化综合征和严重凝血障碍。早期使用阿昔洛韦治疗最终预后良好。
尽管其发生率相对较低，但对于急性肝衰竭的免疫功能正常患者，应考虑单纯疱疹病毒性肝炎的诊断。早期阿昔洛韦治疗的益处应促使临床医生在不明原因的肝炎病例中考虑这一罕见诊断，并通过聚合酶链反应（PCR）快速检测血浆中的单纯疱疹病毒（HSV）DNA水平。
