How much do you know about herpes simplex viral hepatitis?

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Herpes simplex virus (HSV) is the first herpes virus isolated in the 1830s.

Humans are the only natural reservoir of HSV.
As the cause of rare viral hepatitis, primary or recurrent HSV infection can cause herpes simplex viral hepatitis.

Although the incidence of acute hepatitis caused by HSV infection is low, most cases can rapidly progress to fulminant liver failure.
Therefore, early recognition and treatment of HSV hepatitis is essential to improve the prognosis of patients.

Clinical manifestations of HSV hepatitis Adult HSV hepatitis is clinically rare and was first reported in 1969.

Limited case reports show that HSV hepatitis occurs more frequently in people with reduced immune function, including pregnancy, glucocorticoid use, HIV infection, and autoimmune diseases.

The clinical manifestations of HSV hepatitis are not significantly different from acute hepatitis caused by other causes.
The skin and mucosal damage of patients is often lacking or atypical, and may only be manifested as a slight increase in transaminase or even acute liver failure.

Other common manifestations of HSV hepatitis include fever, coagulopathy, and acute renal failure.

Diagnosis of HSV hepatitis The diagnostic tools for HSV hepatitis include HSV serology, polymerase chain reaction (PCR) to detect HSV DNA, CT scan, and liver biopsy.

Serological examination of HSV-IgM and determination of HSV-IgG have high false positives and false negatives, and the clinical reference value is limited.

Studies have found that HSV-DNA levels in patients with HSV hepatitis are often >106 genome equivalents/ml, while other infections such as skin and mucous membranes generally do not exceed 105 genome equivalents/ml.
Through comprehensive analysis of HSV-DNA, transaminase (AST, ALT, GGT) Or ALP) and lactate dehydrogenase (LDH) levels can help improve the accuracy of clinical diagnosis.

CT scan results are non-specific, but can show liver enlargement and diffuse low-density foci, suggesting acute liver necrosis.

In addition, liver ultrasonography can also help rule out other suspicious diagnoses.

Although the above-mentioned examination methods have certain effects, liver biopsy is still the gold standard for diagnosing HSV hepatitis.

Pathology showed extensive hepatocyte necrosis, hemorrhage and inflammatory cell infiltration (mainly neutrophils, other inflammatory cells can also be seen), while the structure of the reticular scaffold was normal; eosinophilic Cowdry type A inclusion bodies were seen in the nucleus of liver cells , The most characteristic pathological changes of this disease.

However, liver biopsy is less sensitive in mild patients, and most patients are often unable to perform biopsy due to coagulation dysfunction, which limits its clinical application.

However, if the patient's coagulation function allows, percutaneous liver biopsy is very necessary to determine the condition and prognosis.

In view of the lack of specific clinical manifestations and absolute laboratory tests for HSV hepatitis, the collection of patient medical history is very important.

When clinically encountered high-risk patients with fever, leukopenia, and obvious elevated transaminases (AST is generally higher than ALT), and bilirubin is normal or only slightly elevated, and other common viral hepatitis is excluded Have a high degree of suspicion of this disease.

Treatment of HSV hepatitis The treatment and prognosis of HSV hepatitis depend to a large extent on time.

Symptomatic and supportive treatment includes liver enzyme lowering treatment and bleeding prevention treatment.

The diagnosis of HSV hepatitis is difficult.
When HSV hepatitis is highly suspected or high-risk patients have unexplained acute liver failure, early intravenous use of high-dose acyclovir (ACV) for empirical antiviral therapy can significantly improve the prognosis.

It is worth noting that there are reports in the literature of HSV hepatitis cases with acyclovir resistance, which are common in people with weakened immune function.

For patients with HSV hepatitis who are resistant to acyclovir, foscarnet or cidofovir can be used.

If the antiviral treatment is not effective and the condition worsens and acute liver failure occurs, liver transplantation is currently the only treatment option available.

It should be noted that adult patients should strictly grasp the indications for liver transplantation.

The prognosis of HSV hepatitis The overall prognosis of HSV hepatitis is poor, and the mortality rate is higher once acute liver failure occurs.

Female patients, age >40 years old, immunosuppressed state, ALT>5000U/L, platelet count<75×109/L, abnormal blood coagulation function, hepatic encephalopathy, and no antiviral therapy are independent risk factors suggesting poor prognosis .

Summary HSV hepatitis is a rare, rapidly progressive acute hepatitis that often leads to fulminant liver failure.

Due to the lack of specific clinical manifestations of the disease, early recognition and detailed medical history collection are essential.

In view of its high mortality rate and complications associated with liver transplantation, empiric acyclovir treatment should be considered in patients with high suspicion of HSV hepatitis.

HSV hepatitis can cause severe liver damage, difficult to diagnose, and poor prognosis.
When clinically encountered liver damage of unknown cause, consider common viral hepatitis A, B, C, D, E, drugs, and toxicological properties.
At the same time as liver damage, the possibility of severe liver damage caused by herpes simplex virus should also be considered.

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