Fatal massive hepatic necrosis from varicella-zoster hepatitis

An unusual case of varicella-zoster hepatitis is reported which resulted in fatal massive hepatic necrosis in a 64-year old white female. The patient had had chickenpox 30 years prior to death but no cutaneous zoster at any time. The liver showed typical eosinophilic intranuclear inclusions and herpesvirus virions were demonstrated by electron microscopy. Indirect immunofluorescent serologic studies confirmed remote and recent infection by varicella-zoster virus. The potential significance of an incidental splenectomy performed 14 months before death and the general role of immunosuppression in the incidence and dissemination of varicella-zoster are discussed. The features of 13 reported cases of herpes simplex hepatitis are briefly reviewed.