Published online Feb 16, 2018. doi: 10.12998/wjcc.v6.i2.11
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
A healthy 72-year-old man developed fatal herpes simplex hepatitis 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).
Several factors specific for postsurgical condition including hemodynamic changes, hepatotoxic drugs, anesthesia, and septic infection make complicated in differential diagnosis of postoperative hepatitis.
A rapid elevation of liver aminotransferases (aspartate aminotransferase > alanine aminotransferase) without alteration of cholestasis was followed by coagulation disorder and encephalopathy.
A contrast-enhanced computed tomography showed heterogeous contrast distribution and a mottled liver without any abscess formation.
Postmortem liver biopsy revealed diffuse necrosis and loss of normal architecture with characteristic findings of intranuclear inclusions.
Empiric therapy with acyclovir, intravenous injection (10 mg/kg, every eight hours) was initiated on postoperative day 8.
Fatal herpetic hepatitis occurs in non-surgical healthy adults as well, whereas the disease following surgery is rarer and is more difficult for precise diagnosis.
Development of herpetic hepatitis is fatal complication following surgery, because of the difficulty for precise diagnosis and rapid deterioration of the disease.
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.