Inthasot Valentine, Goushchi Adonis, Lazzaroni Silvia, Papaleo Alberto, Galdon Maria Gomez, Chochrad Didier
Internal Medicine Department, Iris South Hospitals, Brussels, Belgium.
Anatomical Pathology Department Institut Jules Bordet, Brussels, Belgium.
Eur J Case Rep Intern Med. 2018 Dec 27;5(12):000982. doi: 10.12890/2018_000982. eCollection 2018.
Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive . After empirical treatment with piperacillin-tazobactam was initiated, the patient's condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.
Herpes simplex virus hepatitis should be considered in patients with acute liver failure.This condition can occur even in immunocompetent individuals.Empirical treatment with aciclovir should be initiated in case of clinical suspicion.
单纯疱疹病毒在全球范围内流行，在发达国家估计血清阳性率约为70%。然而，鲜为人知的是，它们是暴发性肝炎（<2%）的病毒病因之一，在急性肝衰竭的所有病因中占比<1%。我们描述了一例89岁男性病例，该患者因药物敏感的尿路感染引发败血症。在开始使用哌拉西林 - 他唑巴坦进行经验性治疗后，患者病情恶化，出现休克、急性肝肾功能衰竭、脑病及持续发热，随后被收入重症监护病房。急腹症的出现促使进行了剖腹探查术，但患者术后不久因腹腔出血死亡。肝活检标本的免疫组织化学分析确定为单纯疱疹病毒性肝炎。作者强调需要更好地了解这种罕见疾病，以便更准确地识别有风险的患者，这些患者需要更积极的评估和经验性治疗，尤其是那些出现明显肝细胞溶解且临床病情迅速恶化的患者。
急性肝衰竭患者应考虑单纯疱疹病毒性肝炎。这种情况甚至可发生在免疫功能正常的个体中。临床怀疑时应开始使用阿昔洛韦进行经验性治疗。
