Fatal fulminant herpes simplex hepatitis following surgery in an adult

Table 2 Clinico-laboratory findings of herpetic hepatitis in postsurgical and non-surgical immunocompetent patients

	Postsurgical patients (n = 15)	Non-surgical patients (n = 42)	P value
Gender (M/F) (n)	8/7	18/24	0.454
Age (yr)	58 (15-93) (n = 15)	44 (15-87) (n = 43)	0.060
Clinical manifestation
(present/absent or ND)
Fever (n)	14/1	42/0	0.263
Nausea, vomiting, diarrhea (n)	6/9 (17.5%)	10/32 (23.8%)	0.312
Herpetic lesion present/none (n)	3/8 (27.3%)	20/19 (51.2%)	0.308
Transmission route
Identified or suspected (n)	3 (20%)	10 (23.8%)	0.535
	Surgical wounds (Trans-genital tracts) (n = 2)	Sexually (n = 6)
	Tran-esophagus (n = 1)	Percutaneous (n = 1)
		Trans-esophagus (n = 2)
		Trans-rectum (n = 1)
Leukocyte count (/mm3)	3905 (900-10100) (n = 14)	2600 (1000-7300) (n = 39)	0.152
AST (U/L)	10,340 (5000-20692) (n = 10)	5664 (92-18937) (n = 39)	0.006
ALT	5116 (2970-7000) (n = 8)	3248 (141-13980) (n = 29)	0.048
Total bilirubin (mg/dL)	2.1 (2-8.5) (n = 6)	4.4 (0.1-35) (n = 25)	0.154
Serology
positive/negative (n)	2/3 (40%)	14/12 (53.8%)	0.654
PCR analyzed (yes/no) (n)	3/12 (20%)	5/39 (8.4%)	0.407
HSV type (1/2/1 and 2) (n)	5/3/0	14/14/3	1.0
Ante-mortem diagnosis
yes/no (n)	3/12 (20%)	24/18 (57.1%)	0.017
ACV treatment
Yes/ no (n)	3/12 (20%)	21 / 21 (50%)	0.041
Liver transplantation
Yes/no (n)	2/13	6/38	1.0
Outcome
Survived/ died (overall) (n)	2/13 (13.3%)	12/30 (28.6%)	0.312
Survival time12 (d)	13 (6-30) (n = 12)	10 (5-29) (n = 26)	0.729
Survival time2 after liver dysfunction emerged (d)	5.5 (1-9) (n = 11)	5 (1-16)) (n = 18)	0.821

Continuous data were presented as median with range from minimum and maximum values. For categorical variables and continuous measures, differences were compared using Fisher’s exact test or χ² test, and the Mann-Whitney U test, respectively.

¹Survival time: were expressed as the days after surgery or symptoms emerging;

²Survival time: Data were excluded from the surviving patients. ACV: Acyclovir; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HSV: Herpes simplex virus; LT: Liver transplantation; PCR: Polymerase chain reaction.