Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report
  • Valentine Inthasot
    Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
  • Adonis Goushchi
    Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
  • Silvia Lazzaroni
    Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
  • Alberto Papaleo
    Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
  • Maria Gomez Galdon
    Anatomical Pathology Department Institut Jules Bordet, Brussels, Belgium
  • Didier Chochrad
    Intensive Care Unit, Iris South Hospitals, Brussels, Belgium


Acute liver failure, hepatitis, herpes simplex virus, septic shock


Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive Escherichia coli. After empirical treatment with piperacillin-tazobactam was initiated, the patient’s condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.



  • Roizman B, Knipe DM, Whitley RJ. Herpes simplex virus. In: Knipe DM, Howley PM, editors. Fields virology, 5th edn. Baltimore: Lippincott Williams & Wilkins; 2007, pp. 2502–2557.

  • Schiødt FV, Davern TJ, Shakil AO, McGuire B, Samuel G, Lee WM. Viral hepatitis-related acute liver failure. Am J Gastroenterol 2003;98:448–453.

  • Kaufman B, Gandhi SA, Louie E, Rizzi R, Illei P. Herpes simplex virus hepatitis: case report and review. Clin Infect Dis 1997;24:334–338.

  • Norvell JP, Blei AT, Jovanovic BD, Levitsky J. Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases. Liver Transpl 2007;13:1428–1434.

  • Ichai P, Roque Afonso AM, Sebagh M, Gonzalez ME, Codés L, Azoulay D, et al. Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis. Liver Transpl 2005;11:1550–1555.

  • Beersma MF, Verjans GM, Metselaar HJ, Osterhaus AD, Berrington WR, van Doornum GJ. Quantification of viral DNA and liver enzymes in plasma improves early diagnosis and management of herpes simplex virus hepatitis. J Viral Hepat 2011;18:e160–e166.

  • Levitsky J, Duddempudi AT, Lakeman FD, Whitley RJ, Luby JP, Lee WM, et al. Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. Liver Transpl 2008;14:1498–1504.

  • Tripuraneni V, Patel K, Brennan TV, Ho LM. Fulminant herpes simplex viral hepatitis: ultrasound and CT imaging appearance and a review of the imaging literature. Clin Imaging 2014;38:191–194.

  • Navaneethan U, Lancaster E, Venkatesh PG, Wang J, Neff GW. Herpes simplex virus hepatitis - it's high time we consider empiric treatment. J Gastrointestin Liver Dis 2011;20:93–96.
  • Views: 3142
    HTML downloads: 147
    PDF downloads: 601

    Published: 2018-11-27
    Issue: Vol 5 No 12 (view)

    How to cite:
    Inthasot V, Goushchi A, Lazzaroni S, Papaleo A, Gomez Galdon M, Chochrad D. Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report. EJCRIM 2018;5 doi:10.12890/2018_000982.