Ehwarieme Rukevwe, Agarwal Apeksha N, Alkhateb Rahaf, Bowling Jason E, Anstead Gregory M
Medicine/Infectious Diseases, University of Texas Health, San Antonio, San Antonio, USA.
Pathology, University of Texas Health, San Antonio, San Antonio, USA.
Cureus. 2021 Sep 5;13(9):e17744. doi: 10.7759/cureus.17744. eCollection 2021 Sep.
Herpes simplex virus (HSV) hepatitis is a rare complication of HSV infection, and a rare cause of hepatitis. It is often fatal, especially if the diagnosis and treatment are delayed. Herein, we describe the case of a 31-year-old female with a history of receiving cytotoxic cancer chemotherapy five months prior who presented with a one-week history of worsening abdominal pain and fever. She was noted to have an outbreak of genital herpes at the time of presentation. Computed tomography (CT) scan of the abdomen showed innumerable hypodensities compatible with hepatic micro-abscesses. A specimen from a subsequent liver biopsy revealed HSV-type cytopathic changes and nuclear staining with an anti-HSV immunohistochemical stain. She was initially started on high-dose oral valacyclovir for genital herpes and was noted to have rapid clinical improvement prior to the histopathologic diagnosis of HSV hepatitis. She achieved full recovery while on oral valacyclovir. This is the first reported case of HSV hepatitis treated with oral valacyclovir and the third reported case of HSV hepatitis mimicking pyogenic abscesses on abdominal imaging. With the high mortality rate associated with HSV hepatitis, one should consider the diagnosis in all patients with multifocal liver lesions of unknown etiology, especially if genital herpes is present at the time of presentation, or in patients who are immunocompromised.
单纯疱疹病毒（HSV）肝炎是HSV感染的一种罕见并发症，也是肝炎的罕见病因。它通常是致命的，尤其是诊断和治疗延迟时。在此，我们描述了一名31岁女性的病例，该女性在5个月前有接受细胞毒性癌症化疗的病史，出现了为期一周的腹痛加重和发热症状。就诊时发现她有生殖器疱疹发作。腹部计算机断层扫描（CT）显示无数低密度影，符合肝微脓肿表现。后续肝脏活检标本显示HSV型细胞病变改变以及抗HSV免疫组化染色的核染色。她最初开始接受高剂量口服伐昔洛韦治疗生殖器疱疹，在HSV肝炎组织病理学诊断之前临床症状迅速改善。她在口服伐昔洛韦期间实现了完全康复。这是第一例报道用口服伐昔洛韦治疗的HSV肝炎病例，也是第三例报道在腹部影像学上类似化脓性脓肿的HSV肝炎病例。鉴于HSV肝炎的高死亡率，对于所有病因不明的多灶性肝脏病变患者都应考虑诊断，特别是就诊时存在生殖器疱疹的患者，或免疫功能低下的患者。
