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  • Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases
  • Norvell JP; Blei AT; Jovanovic BD; Levitsky J
  • Liver Transpl 2007[Oct]; 13 (10): 1428-34
  • Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovir-treated patients as compared to 88% in the untreated subjects (P=0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age>40 yr, immunocompromised state, ALT>5,000 U/L, platelet count<75x10(3)/L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.
  • |*Periodicals as Topic[MESH]
  • |Adult[MESH]
  • |Female[MESH]
  • |Hepatitis, Viral, Human/complications/epidemiology/*virology[MESH]
  • |Humans[MESH]
  • |Incidence[MESH]
  • |Liver Failure, Acute/epidemiology/*etiology/surgery[MESH]
  • |Liver Transplantation/statistics & numerical data[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Retrospective Studies[MESH]
  • |Survival Rate/trends[MESH]

  • *{{pmid17902129}}
    *<b>[ Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases ]</b> Liver Transpl 2007; 13(10) ; 1428-34 Norvell JP; Blei AT; Jovanovic BD; Levitsky J


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    Liver Transpl

    1428 10.13 2007