Fatal fulminant herpes simplex hepatitis following surgery in an adult

作     者：Yoshihiro Yokoi Takeshi Kaneko Tomoki Sawayanagi Yasuo Takano Yoichi Watahiki 

作者机构：Department of Surgery Shinshiro Municipal Hospital Department of Pathology Shinshiro Municipal Hospital 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2018年第6卷第2期

页      面：11-19页

核心收录：

学科分类：10[医学] 

主　　题：Herpes simplex virus Fulminant hepatitis Postsurgical Adult Acyclovir 

摘      要：We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus(HSV) type-1. The serum tests(available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.