Acute herpes hepatitis in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Virology

Background:

• Systemic herpes simplex virus (HSV) infections during pregnancy are rare but can have severe consequences.
• Maternal infections can lead to adverse pregnancy outcomes, including preterm labor and fetal demise.
• Diagnosis of systemic HSV can be challenging, especially in the absence of characteristic mucocutaneous lesions.

Observation:

• A 36-year-old primigravid woman presented with flu-like symptoms and premature labor in the second trimester.
• She developed severe pneumonitis and hepatitis, leading to the delivery of stillborn twins at 25 weeks gestation.
• Herpes simplex virus was isolated from one placenta, with viral DNA and antigen found in maternal monocytes.

Findings:

• The case highlights a rare instance of systemic herpes simplex virus infection presenting without mucocutaneous lesions.
• Diagnosis was confirmed retrospectively, underscoring the limitations of initial antibody studies in acute settings.
• The presence of HSV within maternal monocytes suggests a potential mechanism for systemic viral dissemination.

Implications:

• This case emphasizes the importance of considering systemic HSV infection in pregnant patients with unexplained severe illness, even without skin manifestations.
• Early recognition and appropriate antiviral treatment are crucial to improve maternal and fetal outcomes.
• Further research into the role of monocytes in HSV pathogenesis during pregnancy may offer new diagnostic and therapeutic strategies.