Acute Liver Failure due to Herpes Simplex Viral Hepatitis Diagnosed by Skin Lesions and Blood Tests

A Case Report

Kento Shionoya; Makoto Kako; Sakue Masuda; Makomo Makazu; Kazuya Koizumi

J Med Case Reports. 2023;17(338)

Abstract and Introduction

Abstract

Background: The incidence of acute liver failure from herpes simplex virus is rare.

Case Presentation: A 71-year-old Japanese man was diagnosed with acute liver failure and was transferred to our hospital. Steroid therapy, plasma exchange, and hemodiafiltration were started for liver failure, and antimicrobial therapy was initiated for pneumonia. Staphylococcus epidermidis was detected in blood culture. Skin rash appeared; a positive anti-herpes simplex virus result led to the diagnosis of acute liver failure from herpes simplex virus. Hence, acyclovir was started. After blood tests improved, treatments for acute liver failure were discontinued. Antimicrobial therapy was continued; however, he died. In this case, persistent bacteremia and drug-induced liver damage due to acyclovir may have contributed to his death.

Conclusions: Acute liver failure can lead to complications and death. Thus, careful observation is crucial, even if the patient has shown some improvements.

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Table 1. Laboratory data on the day of the transfer to our hospital
Biochemistry		Na	127 mmol/L	Immunological tests
AST	1049 IU/L	K	4.6 mmol/L	HBc Ab	(−)
ALT	673 IU/L	Cl	93 mmol/L	HBs Ag	(−)
LDH	1437 IU/L	Ca	7.3 mg/dL	HBs Ab	(+)
γ-GTP	413 IU/L	IP	3.5 mg/dL	HCV Ab	(−)
ChE	158 IU/L	Blood cell count		ANA	(−)
Cr	1.82 mg/dL	WBC	6900/μL	IgM-HAV	(−)
BUN	43.1 mg/dL	Hb	16.6 g/dL	HSV-IgM	(+)
T-Bil	11.8 mg/dL	Plt	78,000/μL	HSV-IgG	(+)
D-Bil	8 mg/dL	Coagulation tests		VZV-IgM	(−)
CK	85 IU/L	PT	29.3 seconds	VZV-IgG	(+)
Alb	2.6 mg/dL	PT%	23.3	EBV-IgM	(−)
Fe	56 μg/dL	PT–INR	2.62	EBV-IgG	(+)
Ammonia	118 μg/dL	APTT	46.5	CMV-IgM	(−)
Ferritin	14,009 ng/mL	D-dimer	19.7 μg/mL	CMV-IgG	(+)
CRP	29.48 mg/dL	Fib	602.3 mg/dL	IgA-HEV	(−)
		FDP	34.3 μg/dL	AMA	(−)
		AT-III	44.1	HSV-PCR	1000/μg DNA

γ-GTP γ-glutamyl transferase, Alb albumin, ALP alkaline phosphatase, ALT alanine aminotransferase, AMA anti-mitochondrial antibody, APTT activated partial thromboplastin time, AST aspartate aminotransferase, AT-III antithrombin-III, BUN blood urea nitrogen, Ca calcium, ChE cholinesterase, CK creatine kinase, Cl chloride, Cre creatinine, CRP C-reactive protein, D-Bil direct bilirubin, EBV Epstein–Barr virus, FDP fibrinogen degradation product, Fe iron, Hb hemoglobin, HBcAb hepatitis B core antibody, HBsAb hepatitis B surface antibody, HBsAg hepatitis B surface antigen, HCV Ab hepatitis C virus antibody, Ht hematocrit, Ig immunoglobulin, IP inorganic phosphorus, K potassium, LDH lactate dehydrogenase, Na sodium, Plt platelet count, PT prothrombin time, PT% percentage of prothrombin, PT–INR prothrombin time–international normalized ratio, RBC red blood cell count, T-Bil total bilirubin, TP total protein, VZV varicella-zoster virus, WBC white blood cell count