Autopsy and Case Reports
Autopsy and Case Reports
Autopsy Case Report

Fulminating herpes simplex hepatitis

Raheel Ahmed; Kesley Green; Silvio Litovsky; Sameer Al Diffalha

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Herpes simplex virus (HSV) is a rare cause of acute hepatitis in patients with chronic immunosuppression, including Crohn’s disease. HSV hepatitis has the propensity to cause acute liver failure and death. The presenting signs and symptoms can be nonspecific, thereby causing the diagnosis to go overlooked with inadequate management, leading to a high mortality rate. We report a case of a 31-year-old male on chronic prednisone treatment for Crohn’s disease who unexpectedly died. Subsequently, an autopsy showed HSV hepatitis as the cause of death. Thus, although a rare complication, HSV hepatitis should always be kept in mind as a fatal complication in patients with acute hepatitis and chronic immunosuppression.


Herpes Simplex Virus, Hepatitis, Crohn’s Disease, Prednisone


1 James C, Harfouche M, Welton NJ, et al. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bull World Health Organ. 2020;98(5):315-29. PMid:32514197.

2 Thomas DL. Global elimination of chronic hepatitis. N Engl J Med. 2019;380(21):2041-50. PMid:31116920.

3 Ahmed A, Granillo A, Burns E, et al. Herpes simplex virus-2 hepatitis: a case report and review of the literature. Case Rep Med. 2020;2020:8613840. PMid:32148514.

4 Kusne S, Schwartz M, Breinig MK, et al. Herpes simplex virus hepatitis after solid organ transplantation in adults. J Infect Dis. 1991;163(5):1001-7. PMid:1850439.

5 Toomey DP, Dhadda AS, Sanni LA, Cooke JP, Hartley JE. Fatal herpes simplex virus hepatitis following neoadjuvant chemoradiotherapy and anterior resection for rectal cancer. Ann R Coll Surg Engl. 2014;96(8):e12-4. PMid:25350168.

6 Poley RA, Snowdon JF, Howes DW. Herpes simplex virus hepatitis in an immunocompetent adult: a fatal outcome due to liver failure. Case Rep Crit Care. 2011;2011:138341. PMid:24826316.

7 Mehta A, Down C, Salama G, Hissong EM, Rosenblatt R, Cantor M. Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses: 1839. Am J Gastroenterol. 2016;111:S881-3.

8 Knösel T, Schewe C, Petersen N, Dietel M, Petersen I. Prevalence of infectious pathogens in Crohn’s disease. Pathol Res Pract. 2009;205(4):223-30. PMid:19186006.

9 Haag LM, Hofmann J, Kredel LI, et al. Herpes simplex virus sepsis in a young woman with Crohn’s disease. J Crohns Colitis. 2015;9(12):1169-73. PMid:26351382.

10 Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187-93. PMid:23403598.

11 Looker KJ, Magaret AS, May MT, et al. Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012. PLoS One. 2015;10(10):e0140765. PMid:26510007.

12 Riediger C, Sauer P, Matevossian E, Müller MW, Büchler P, Friess H. Herpes simplex virus sepsis and acute liver failure. Clin Transplant. 2009;23(Suppl 21):37-41. PMid:19930315.

13 Wolfsen HC, Bolen JW, Bowen JL, Fenster LF. Fulminant herpes hepatitis mimicking hepatic abscesses. J Clin Gastroenterol. 1993;16(1):61-4. PMid:8421151.

14 Down C, Mehta A, Salama G, et al. Herpes simplex virus hepatitis in an immunocompetent host resembling hepatic pyogenic abscesses. Case Reports Hepatol. 2016;2016:8348172. PMid:27872770.

15 Mortelé KJ, Segatto E, Ros PR. The infected liver: radiologic-pathologic correlation. Radiographics. 2004;24(4):937-55. PMid:15256619.

16 Longerich T, Eisenbach C, Penzel R, et al. Recurrent herpes simplex virus hepatitis after liver retransplantation despite acyclovir therapy. Liver Transpl. 2005;11(10):1289-94. PMid:16184558.

17 Beck J, Haggard H, Membreno F. The first documented case of fulminant liver failure from herpes simplex virus in an immunocompromised patient taking to facitinib. GastroHep. 2020;2(5):253-256.

18 Kusne S, Schwartz M, Breinig MK, et al. Herpes simplex virus hepatitis after solid organ transplantation in adults. J Infect Dis. 1991;163(5):1001-7. PMid:1850439.

19 Natu A, Iuppa G, Packer CD. Herpes simplex virus hepatitis: a presentation of multi-institutional cases to promote early diagnosis and management of the disease. Case Reports Hepatol. 2017;2017:3180984. PMid:28835860.

20 Sharma S, Mosunjac M. Herpes simplex hepatitis in adults: a search for muco-cutaneous clues. J Clin Gastroenterol. 2004;38(8):697-704. PMid:15319655.

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