Acute Herpes Simplex Virus Hepatitis in Pregnancy.

Area of Science:

• Hepatology
• Virology
• Obstetrics

Background:

• Herpes simplex virus (HSV) is an uncommon cause of acute hepatitis, accounting for 2-4% of cases.
• Pregnancy is identified as a significant risk factor for developing severe HSV hepatitis, associated with high morbidity and mortality.
• This report details a unique case of HSV hepatitis occurring during pregnancy.

Observation:

• A 32-year-old pregnant woman at 38 weeks gestation presented with symptoms including back pain and fetal distress.
• Post-delivery, the patient developed persistent fever, liver dysfunction (transaminitis), hypotension, and pancytopenia.
• Diagnostic imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy.

Findings:

• Serum polymerase chain reaction (PCR) testing confirmed Herpes simplex virus type 1 (HSV-1) infection.
• The patient's condition improved significantly following treatment with the antiviral medication acyclovir.
• No evidence of HSV transmission or seroconversion was observed in the neonate.

Implications:

• Herpes simplex virus hepatitis poses a substantial risk of severe illness, particularly in pregnant individuals.
• Early and accurate diagnosis of HSV hepatitis in pregnant or peripartum women presenting with acute febrile hepatitis is essential.
• Prompt evaluation utilizing serum PCR screening is recommended for timely initiation of antiviral therapy, such as acyclovir.