Two Fatal Cases of Acute Liver Failure Due to HSV-1 Infection in COVID-19 Patients Following Immunomodulatory Therapies

Stefano Busani; Andrea Bedini; Emanuela Biagioni; Lucia Serio; Roberto Tonelli; Marianna Meschiari; Erica Franceschini; Giovanni Guaraldi; Andrea Cossarizza; Enrico Clini; Antonino Maiorana; William Gennari; Nicola De Maria; Mario Luppi; Cristina Mussini; Massimo Girardis; Modena Covid-19 Working Group (MoCo19)

doi:10.1093/cid/ciaa1246

Two Fatal Cases of Acute Liver Failure Due to HSV-1 Infection in COVID-19 Patients Following Immunomodulatory Therapies

Clin Infect Dis. 2021 Jul 1;73(1):e252-e255. doi: 10.1093/cid/ciaa1246.

Authors

Stefano Busani¹, Andrea Bedini², Emanuela Biagioni¹, Lucia Serio¹, Roberto Tonelli³, Marianna Meschiari², Erica Franceschini², Giovanni Guaraldi², Andrea Cossarizza⁴, Enrico Clini³, Antonino Maiorana⁵, William Gennari⁶, Nicola De Maria⁷, Mario Luppi⁸, Cristina Mussini², Massimo Girardis¹; Modena Covid-19 Working Group (MoCo19)

Collaborators

Modena Covid-19 Working Group (MoCo19):
Massimo Girardis, Alberto Andreotti, Emanuela Biagioni, Filippo Bondi, Stefano Busani, Giovanni Chierego, Marzia Scotti, Lucia Serio, Annamaria Ghirardini, Marco Sita, Stefano De Julis, Lara Donno, Lorenzo Dall'Ara, Fabrizio Di Salvo, Carlotta Farinelli, Laura Rinaldi, Ilaria Cavazzuti, Andrea Ghidoni, Antonio Buono, Elena Ferrari, Daniela Iseppi, Anna Maria Ardito, Irene Coloretti, Sophie Venturelli, Elena Munari, Martina Tosi, Erika Roat, Ilenia Gatto, Marco Sarti, Andrea Cossarizza, Caterina Bellinazzi, Rebecca Borella, Sara De Biasi, Anna De Gaetano, Lucia Fidanza, Lara Gibellini, Anna Iannone, Domenico Lo Tartaro, Marco Mattioli, Milena Nasi, Annamaria Paolini, Marcello Pinti, Cristina Mussini, Giovanni Guaraldi, Marianna Meschiari, Alessandro Cozzi-Lepri, Jovana Milic, Marianna Menozzi, Erica Franceschini, Gianluca Cuomo, Gabriella Orlando, Vanni Borghi, Antonella Santoro, Margherita Di Gaetano, Cinzia Puzzolante, Federica Carli, Andrea Bedini, Luca Corradi, Enrico Clini, Roberto Tonelli, Riccardo Fantini, Ivana Castaniere, Luca Tabbì, Giulia Bruzzi, Chiara Nani, Fabiana Trentacosti, Pierluigi Donatelli, Maria Rosaria Pellegrino, Linda Manicardi, Antonio Moretti, Morgana Vermi, Caterina Cerbone, Monica Pecorari, William Gennari, Antonella Grottola, Giulia Fregni Serpini

Affiliations

¹ Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
² Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
³ Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
⁴ Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
⁵ Institute of General Pathology, University of Modena and Reggio Emilia, Modena, Italy.
⁶ Virology and Molecular Microbiology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
⁷ Gastroenterology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
⁸ Hematology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Abstract

We report two fatal cases of acute liver failure secondary to herpes simplex virus 1 infection in COVID-19 patients, following tocilizumab and corticosteroid therapy. Screening for and prompt recognition of herpes simplex virus 1 reactivation in these patients, undergoing immunomodulatory treatment, may have potentially relevant clinical consequences.

MeSH terms

COVID-19*
Herpes Simplex*
Herpesvirus 1, Human*
Humans
Immunomodulation
Liver Failure, Acute*
SARS-CoV-2