FATAL HERPES-SIMPLEX HEPATITIS TYPE-2 IN A POST-THYMECTOMIZED ADULT

The authors report an unusual case of herpes simplex type 2 (HSV) hepa titis which presented as part of a systemic HSV infection accompanied by disseminated intravascular coagulation (DIC). The patient was a 49- year-old Japanese male who three months prior to admission underwent s urgical resection of his thymus for an invasive thymoma. Postoperative ly, he received a course of chemotherapy which included prednisone, cy clophosphamide, vincristine, and pinorubicin. After discharge from the hospital, he was put on a maintenance dosage of prednisone and cyclop hosphamide. Two weeks prior to this admission, the patient developed r hinorrhea, chills and general fatigue. Routine follow-up laboratory te sts revealed markedly elevated liver enzymes which led to his immediat e hospitalization. The tentative diagnosis on admission was fulminant hepatitis with DIC. The patient's condition steadily worsened during h is hospitalization and acyclovir was initiated on the 4th hospital day due to the possibility of HSV hepatitis. He died on the same day. His topathology performed on the liver at autopsy revealed hepatic inclusi on bodies of HSV with positive immunohistochemical detection of the HS V type 2 antigen. Our case is the first report of HSV hepatitis associ ated with the removal of the thymus secondary to thymoma. It supports previous observations of disseminated HSV infection being prevalent in those patients with disorders of cell mediated immunity.