[Hepatitis due to herpes group viruses]

Area of Science:

• Hepatology
• Virology
• Immunology

Context:

• Herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), human herpesvirus 6, and Epstein-Barr virus (EBV) are common causes of hepatitis.
• In immunocompetent individuals, these infections typically result in mild, self-limiting hepatitis.
• However, specific populations, including neonates, pregnant women, transplant recipients, and immunocompromised individuals, are at higher risk for severe or fulminant hepatitis.

Purpose:

• To review the spectrum of hepatitis caused by herpes viruses.
• To highlight risk factors and clinical presentations of herpes virus-induced hepatitis.
• To emphasize the importance of early diagnosis and treatment for fulminant herpes virus hepatitis.

Summary:

• Primary herpes virus infections (HSV, VZV, CMV, HHV-6, EBV) usually cause mild hepatitis in immunocompetent patients.
• Fulminant hepatitis can occur in neonates/pregnant women (HSV), transplant recipients (VZV, CMV), and those with active chronic EBV infection.
• CMV hepatitis in liver transplant recipients mimics acute rejection.
• Early treatment of fulminant herpes virus hepatitis is effective, necessitating high clinical suspicion.

Impact:

• Early recognition of herpes virus hepatitis can lead to timely intervention and improved patient outcomes.
• Understanding the varied presentations of herpes virus hepatitis is critical for differential diagnosis, especially in at-risk populations.
• This review underscores the need to include herpes viruses in the differential diagnosis of acute and fulminant hepatitis.