Fulminant hepatitis is a rare and fatal complication of Herpes simplex virus 1 (HSV1) infection, which can affect both immunocompetent and immunodeficient adults. The diagnosis is often delayed due to the rapid evolution of the infection, hence the importance of initiating rapid treatment with aciclovir. We report the case of a 36-year-old patient with no medical history who consulted for sudden asthenia after two days of fever and myalgia. The initial laboratory workup revealed hepatic cytolysis and bicytopenia (thrombocytopenia and leukopenia). The evolution was rapidly unfavorable, with the development of acute hepatic failure and a reactive hemophagocytic syndrome. The etiological workup then revealed an HSV1 infection. Treatment with aciclovir resulted in clinical and biological improvement, and the patient fully recovered.
What is already known about the topic?
HSV1 hepatitis is a rare and fatal infection that might be difficult to diagnose. However, prompt management of the disease improves its prognosis. It affects both immunocompetent and immunodeficient people. In rare cases, severe herpetic infections such as herpetic hepatitis may be complicated by a reactive hemophagocytic syndrome that worsens the prognosis. Early treatment with aciclovir reduces the mortality rate of both diseases and the risk of liver transplantation.
What does this article bring up for us?
This article provides the clinician with a variety of clinical and laboratory features allowing for the early diagnosis of herpetic hepatitis in order to initiate treatment promptly. In addition, it provides a brief reminder of reactive hemophagocytic syndrome: a rare but fatal complication of this infection.
Key Words
Herpes simplex virus 1, hepatitis, reactive hemophagocytic syndrome, immunocompetence.