Acute liver failure due to herpes simplex viral hepatitis diagnosed by skin lesions and blood tests: a case report

J Med Case Rep. 2023 Aug 10;17(1):338. doi: 10.1186/s13256-023-04083-w.

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.

Keywords: Acute liver failure; Acyclovir; Case report; Hemodiafiltration; Herpes simplex viral hepatitis; Plasma exchange.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use
  • Aged
  • Antiviral Agents / therapeutic use
  • Hepatitis, Viral, Human* / complications
  • Hepatitis, Viral, Human* / diagnosis
  • Hepatitis, Viral, Human* / drug therapy
  • Herpes Simplex* / complications
  • Herpes Simplex* / diagnosis
  • Herpes Simplex* / drug therapy
  • Humans
  • Liver Failure, Acute* / diagnosis
  • Liver Failure, Acute* / drug therapy
  • Male

Substances

  • Antiviral Agents
  • Acyclovir