Reactivation of Herpes Simplex Causing Submassive Hepatic Necrosis in a Liver Recipient
Journal
Formosan Journal of Surgery
Journal Volume
41
Journal Issue
1
Pages
15-19
Date Issued
2008
Author(s)
Abstract
Survival from herpes simplex virus (HSV)-induced submassive hepatic necrosis in a liver recipient is rare. A 48-year-old man, with underlying HBV-related liver cirrhosis underwent living-related liver transplantation, had progressive hyperbilirubinemia and hepatic failure which occurred 2 months after surgery. Small amounts of YMDD mutated HBV DNA were found in serum but the patient responded poorly to lamivudin plus adefovir. Two sequential liver biopsies were performed and only the second one was characteristic of submassive hepatic necrosis with a Cowdry type I intranuclear inclusion body, which was confirmed to be HSV type I infection by immunohistochemistry. Retrospective immuno-staining and DNA detection by real time PCR of the first specimen were both negative. Serologic antibody titers were positive pre-and post-operatively. Intravenous acyclovir was administered and the liver function dramatically recovered. There were no clinical signs of oral or genital reactivation of HSV, fever, leucopenia, or thrombocytopenia. Early diagnosis was vital but difficult. Reevaluation and therapeutic decisions should not be delayed in clinically undetermined situations.
SDGs
Type
journal article