Herpes simplex type 2 causing fulminant hepatic failure

Although exceedingly rare, fulminant hepatic failure (FHF) in immunocompete nt patients can develop with primary or recurrent infection due to herpes s implex virus (HSV). The diagnosis is frequently obscured by the absence of mucocutaneous involvement, Elevated transaminase values with leukopenia and a relatively low bilirubin level may provide clues to the diagnosis. We de scribe an immunocompetent woman who died of FHF before a definitive diagnos is of HSV type 2 hepatitis was established. Herpes simplex virus hepatitis is one of the few causes of FHF for which potentially effective therapy is available, Thus, early diagnosis is paramount and usually requires liver bi opsy. Recent studies suggest that transjugular liver biopsy is safe and eff ective in establishing the cause of FHF. Since the diagnosis and management of FHF are frequently influenced by the results of transjugular liver biop sy, it may become a standard diagnostic tool for managing FHF in centers wh ere such expertise exists.