Successful liver transplantation in a kidney and pancreas allograft recipient with fulminant herpes simplex virus type 2 hepatitis

Abstract

Herpes simplex virus (HSV) is an infrequent cause of viral hepatitis, accounting for 1.4% [1] of all cases with acute liver failure, and is associated with a high mortality in adults. HSV 1 and 2 can both cause fulminant acute hepatitis that occurs mainly in immunocompromised patients. Symptoms may be unspecific and include fever, abdominal pain and flulike symptoms. Therapeutic options include intravenous acyclovir therapy and liver transplantation [2–6]. Nevertheless, prognosis for fulminant HSV hepatitis is poor and in a recent French report, all five patients with hepatic failure due to HSV died [1], two of them prior to transplantation, two up to 1 month after transplantation; one patient survived for one year. In contrast, a recent publication suggests that the spectrum and severity of HSV hepatitis reported in the literature over-represents fulminant presentations, and that HSV hepatitis in immunocompromised host occurs with a higher frequency and lower mortality than described so far [7]. The following report describes a kidney and pancreas graft recipient with fulminant HSV2 hepatitis, who underwent successful liver transplantation in combination with acyclovir and foscarnet therapy. Case report