FULMINANT-HEPATITIS DURING HERPES-SIMPLEX-VIRUS-INFECTION IN APPARENTLY IMMUNOCOMPETENT ADULTS - REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

Two apparently immunocompetent adult patients developed acute fulminan t hepatitis during presumptive primary herpes simplex virus type 1 (HS V-1) infection without any visible mucocutaneous lesions. HSV hepatiti s was not suspected in the case of patient 1, who died without treatme nt. Patient 2 was empirically treated with acyclovir because of the tr iad of high fever, leukopenia, and markedly elevated levels of aminotr ansferases, and this patient survived. Most immunocompetent patients w ith fulminant HSV hepatitis do not have visible mucocutaneous ulcers, and HSV is frequently not considered as a cause of acute hepatitis. In summary, fulminant hepatitis can occur during HSV infections, the dia gnosis is frequently missed or delayed because of the absence of mucoc utaneous ulcerations, and patients who receive early empirical treatme nt with acyclovir can survive this illness.