Fulminant herpes hepatitis mimicking hepatic abscesses

H. C. Wolfsen, J. W. Bolen, J. L. Bowen, L. F. Fenster

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Fulminant hepatitis due to herpes simplex virus (HSV) in adults is a rare and deadly disease. We describe a 23-year-old woman with a 20-year history of Crohn’s disease (CD) who was hospitalized with an acute febrile illness and diarrhea. A computed tomography (CT) scan of the abdomen demonstrated an intramural sigmoid colon abscess and multiple abscesses in the liver. Despite high-dose parenteral corticosteroids and broad-spectrum antibiotics, the patient remained acutely ill, with high fever and markedly elevated serum transaminase levels, but no jaundice. Sigmoid resection and wedge liver biopsy were performed at laparotomy. Histologic examination documented HSV-type intranuclear inclusions and inflammation with necrosis in both the sigmoid colon and liver specimens. The patient subsequently died despite parenteral acyclovir treatment. Although rare, fulminant hepatitis due to HSV simplex virus should be considered in the differential diagnosis of all patients with severe hepatitis. Of special note, the necrotizing liver lesions may be mistaken for pyogenic abscesses on CT scan.

Original languageEnglish (US)
Pages (from-to)61-64
Number of pages4
JournalJournal of clinical gastroenterology
Volume16
Issue number1
DOIs
StatePublished - Jan 1993

Keywords

  • Crohn’s disease
  • Hepatitis
  • Herpes simplex virus

ASJC Scopus subject areas

  • Gastroenterology

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