Fatal disseminated herpes simplex in pregnancy with maternal and neonatal death

Disseminated herpes is rare in the adult and usually occurs in the immunocompromised. Twenty-one cases have been reported in which healthy women contracted life-threatening disseminated herpes simplex virus (HSV) infections in the third trimester of pregnancy. Most of these patients had nonspecific symptoms, and many did not have mucocutaneous lesions. On physical examination, they were usually febrile and anicteric and had markedly elevated aminotransferase values, without a corresponding elevation in bilirubin level. In our review of the literature, we found that prompt acyclovir therapy resulted in 100% survival. Those patients not receiving treatment or treated late in the terminal stages of their disease had a 63% mortality rate. We report a case of maternal disseminated HSV with subsequent maternal death at an estimated 31 weeks' gestation in which the diagnosis was made at the time of necropsy. The infant was started on acyclovir therapy but died of disseminated HSV.