Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2018; 6(2): 11-19
Published online Feb 16, 2018. doi: 10.12998/wjcc.v6.i2.11
Fatal fulminant herpes simplex hepatitis following surgery in an adult
Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Yasuo Takano, Yoichi Watahiki
Yoshihiro Yokoi, Takeshi Kaneko, Tomoki Sawayanagi, Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
Yasuo Takano, Department of Pathology, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
Author contributions: Yokoi Y, Kaneko T, Sawayanagi T and Watahiki Y participated in the diagnosis and management of this case; Takano Y provided a critical and valuable discussion on the histopathologic study.
Informed consent statement: Informed consent to publish was obtained from the family of the patient.
Conflict-of-interest statement: The authors state that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoshihiro Yokoi, MD, Doctor, Department of Surgery, Shinshiro Municipal Hospital, 32-1 Kitahata, Shinshiro 441-1387, Japan. y.yokoi@hospital.shinshiro.aichi.jp
Telephone: +81-536-222171 Fax: +81-536-222850
Received: November 4, 2017
Peer-review started: November 4, 2017
First decision: November 30, 2017
Revised: December 15, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: February 16, 2018
Processing time: 96 Days and 2.3 Hours
Abstract

We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus (HSV) type-1. The serum tests (available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.

Keywords: Herpes simplex virus; Fulminant hepatitis; Postsurgical; Adult; Acyclovir

Core tip: Fatal fulminant herpetic hepatitis developed in a 72-year-old healthy man following ordinary surgery for biliary stones. A. sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir treatment on day 8. A literature review showed that (1): A wide spectrum of surgical procedures is involved; and (2): High mortality (87%) associated with low rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). An early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.