Adult-onset herpes simplex virus hepatitis with diffuse myofibroblastic transformation of hepatic stellate cells (Ito cells) in non-necrotic areas

The myofibroblastic transformation of hepatic stellate cells (HSC; also kno wn as Ito cells) usually occurs following necrosis of adjacent liver cells. No report has previously found that such a transformation occurs in herpes simplex virus (HSV) hepatitis. We present an autopsy case of HSV hepatitis with myofibroblastic transformation of HSC that is different from the usua l transformation of HSC, The patient was a 66-year-old woman who had receiv ed various therapies for cutaneous T-cell lymphoma. An autopsy revealed sub massive hepatic necrosis with hemorrhage due to HSV hepatitis. HSV infectio n was confirmed by DNA In situ hybridization In liver tissue. Immunohistoch emical staining for a-smooth muscle actin (ASMA) showed a strong positive r eaction in almost all of the HSC in non-necrotic areas. However, in necroti c areas, the HSC were completely negative for ASMA. These findings indicate that not only liver cells but also HSC can become necrotic in HSV hepatiti s. In contrast, In non-necrotic areas, almost all of the HSC showed active transformation to myofibroblasts.