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Fulminant herpes simplex hepatitis in a patient with ulcerative colitis
R D Shlien1, S Meyers, J A Lee
1Department of Medicine, Mount Sinai School of Medicine, City University of New York, New York 10029.
Gut
|February 1, 1988
Summary
A 16-year-old ulcerative colitis patient developed severe hepatitis. Postmortem liver examination confirmed herpes simplex virus type 1 as the cause, even without typical skin lesions.
Area of Science:
- Hepatology
- Virology
- Pathology
Background:
- Ulcerative colitis (UC) management can involve immunosuppressive therapies.
- Severe hepatitis in patients with inflammatory bowel disease requires careful etiological investigation.
Observation:
- A 16-year-old female with UC presented with acute hepatitis, characterized by fever, leukopenia, and elevated transaminases, but no jaundice.
- Clinical presentation lacked mucocutaneous lesions typical of herpes simplex virus (HSV).
- Liver biopsy was not feasible due to coagulopathy.
Findings:
- Postmortem liver examination utilized light and electron microscopy, culture, and immunohistochemistry.
- Diagnosis of hepatitis due to herpes simplex virus type 1 (HSV-1) was confirmed.
- The findings highlight a rare but severe presentation of HSV-1 hepatitis.
Implications:
- Herpes simplex virus type 1 should be considered in the differential diagnosis of severe hepatitis, particularly in immunocompromised patients or those with inflammatory bowel disease.
- The absence of mucocutaneous lesions does not rule out HSV hepatitis.
- Early consideration of viral etiologies can guide timely diagnosis and management of severe hepatitis.
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