Herpes simplex-induced fulminant hepatitis in adults - A call for empiric therapy

Herpes simplex-induced fulminant hepatitis is an infrequently reported caus e of hepatitis in adults. Pregnant females and patients with impaired cellu lar immunity may be at increased risk, although healthy adults have been af fected. The diagnosis may be underrecognized due to nonspecific presenting symptoms and lack of typical cutaneous herpes lesions. We present three cas es of fatal herpes simplex fulminant hepatitis. Our review of case reports of herpes simplex hepatitis in adults demonstrates improved survival with i ntravenous acyclovir therapy. We believe that empiric use of acyclovir shou ld be considered while the diagnostic evaluation of non-acetaminophen-induc ed fulminant hepatitis is underway. Recognition of characteristic liver fun ction abnormalities seen with fulminant herpes simplex hepatitis include ma rked elevation of transaminases with AST > ALT and a mild hyperbilirubinemi a (anicteric hepatitis), and they should prompt acyclovir therapy. This is especially true when there are no obvious risk factors for other forms of h epatitis.