NEONATAL HERPES-SIMPLEX VIRUS HEPATITIS - FAVORABLE OUTCOME WITH ACYCLOVIR

Background. - Herpes simplex virus (HSV) may cause severe disease in t he neonate with high mortality and devastating sequellae. This infecti on presents exceptionally as isolated fulminant hepatitis. Case report . - An 8 day-old baby was admitted because of seizures, fever and vomi ting. Initial investigations including CSF analysis were negative amd the patient was given ampicillin plus netilmicin. Two skin vesicles we re seen 5 days later containing HSV. A second CSF analysis was negativ e as was the brain scan. At that time, liver involvement was evident: ASAT 3700 IU/l; ALAT 1035 IU/l; prothrombin 37%; fibrinogen 1 g/l. Hem ogram showed WBC: 2500/mm(3) and PNN: 702/mm(3). The patient was given acyclovir 40 mg/kg/day IV. Blood and CSF culture remained negative; C SF interferon concentration was 4 IU/ml. Serologic investigations in b oth parents were inconclusive. The disease worsened rapidly with consu mption coagulopathy requiring ventilation support. The dose of acyclov ir was increased to 60 mg/kg/day, 9 days after admission. Improvement was noted on the 10th day and acyclovir was administered orally on the 21st day. The condition was completely normal 6 months later. Conclus ion. - Early administration of acyclovir may favor complete recovery o f neonatal HSV hepatis.