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A Spotty Liver of Pregnancy.

Gray M, Rockey DC - J Investig Med High Impact Case Rep (2014)

Bottom Line: She initially presented with nausea, vomiting, and abdominal pain and was found to have acute hepatocellular liver injury and a systemic inflammatory response syndrome.The patient recovered completely; however, her fetus did not survive.Furthermore, given the high mortality rate and effective treatment, empiric treatment with acyclovir should be considered early in all potential cases.

View Article: PubMed Central - PubMed

Affiliation: Medical University of South Carolina, Charleston, SC, USA.

ABSTRACT
Herpes simplex virus (HSV) hepatitis by definition constitutes disseminated herpes simplex infection; it is rare, with only approximately 130 cases reported in the literature. Although HSV hepatitis typically occurs in immunocompromised hosts, pregnancy-especially the third trimester, has been identified as a risk factor for its development. This is likely because of the fact that humoral and cell-mediated immunity decrease throughout pregnancy and nadir in the third trimester with decreased T-cell counts and altered B/T lymphocyte ratios. Here, we report on a patient with HSV 2 hepatitis in a previously healthy 27-year-old woman in her 23rd week of pregnancy. She initially presented with nausea, vomiting, and abdominal pain and was found to have acute hepatocellular liver injury and a systemic inflammatory response syndrome. Broad-spectrum antibiotics and acyclovir were promptly initiated. Liver biopsy, serum DNA polymerase chain reaction (PCR) as well as a labial ulcer culture and PCR were all positive for HSV 2. The patient recovered completely; however, her fetus did not survive. Review of the literature emphasizes that presentation with disseminated HSV infection typically occurs in the third trimester of pregnancy. This report emphasizes that abdominal pain combined with fever and hepatic dysfunction in pregnancy should prompt immediate consideration of the diagnosis of HSV hepatitis. Furthermore, given the high mortality rate and effective treatment, empiric treatment with acyclovir should be considered early in all potential cases.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemistry. The liver specimen shown in Figure 1 was fixed and labeled with anti-HSV-2 antibody. Brown nuclei, containing HSV 2, are shown. Image provided by David Lewin, MD (Medical University of South Carolina).
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fig2-2324709614551558: Immunohistochemistry. The liver specimen shown in Figure 1 was fixed and labeled with anti-HSV-2 antibody. Brown nuclei, containing HSV 2, are shown. Image provided by David Lewin, MD (Medical University of South Carolina).

Mentions: The patient’s abdominal pain continued to worsen and she developed what was perceived to be an acute abdomen with diffuse peritonitis. Therefore, she was taken to the operating room for diagnostic laparoscopy. Although no pathology was found to explain the peritonitis, the patient was noted to have an abnormal, “spotty” or mottled appearing liver, and a liver biopsy was performed. Liver histology revealed multifocal geographic areas of necrosis with associated neutrophils (Figure 1A). Within the necrotic areas, the nuclei had intranuclear inclusions, ground glass change with margination of the chromatin, and multinucleation (Figure 1B). There was no evidence of fat, and immunohistochemical stains for HSV 2 were positive (Figure 2). An ulcerated lesion from the right labia minora was identified and a culture and viral polymerase chain reaction (PCR) revealed HSV 2. HSV 2 IgG was positive and HSV 2 DNA was also detected in the serum. Cytomegalovirus and Epstein–Barr virus DNA plasma viral loads were negative. HIV 1 and 2 antibodies were negative as was an HIV RNA viral load.


A Spotty Liver of Pregnancy.

Gray M, Rockey DC - J Investig Med High Impact Case Rep (2014)

Immunohistochemistry. The liver specimen shown in Figure 1 was fixed and labeled with anti-HSV-2 antibody. Brown nuclei, containing HSV 2, are shown. Image provided by David Lewin, MD (Medical University of South Carolina).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528901&req=5

fig2-2324709614551558: Immunohistochemistry. The liver specimen shown in Figure 1 was fixed and labeled with anti-HSV-2 antibody. Brown nuclei, containing HSV 2, are shown. Image provided by David Lewin, MD (Medical University of South Carolina).
Mentions: The patient’s abdominal pain continued to worsen and she developed what was perceived to be an acute abdomen with diffuse peritonitis. Therefore, she was taken to the operating room for diagnostic laparoscopy. Although no pathology was found to explain the peritonitis, the patient was noted to have an abnormal, “spotty” or mottled appearing liver, and a liver biopsy was performed. Liver histology revealed multifocal geographic areas of necrosis with associated neutrophils (Figure 1A). Within the necrotic areas, the nuclei had intranuclear inclusions, ground glass change with margination of the chromatin, and multinucleation (Figure 1B). There was no evidence of fat, and immunohistochemical stains for HSV 2 were positive (Figure 2). An ulcerated lesion from the right labia minora was identified and a culture and viral polymerase chain reaction (PCR) revealed HSV 2. HSV 2 IgG was positive and HSV 2 DNA was also detected in the serum. Cytomegalovirus and Epstein–Barr virus DNA plasma viral loads were negative. HIV 1 and 2 antibodies were negative as was an HIV RNA viral load.

Bottom Line: She initially presented with nausea, vomiting, and abdominal pain and was found to have acute hepatocellular liver injury and a systemic inflammatory response syndrome.The patient recovered completely; however, her fetus did not survive.Furthermore, given the high mortality rate and effective treatment, empiric treatment with acyclovir should be considered early in all potential cases.

View Article: PubMed Central - PubMed

Affiliation: Medical University of South Carolina, Charleston, SC, USA.

ABSTRACT
Herpes simplex virus (HSV) hepatitis by definition constitutes disseminated herpes simplex infection; it is rare, with only approximately 130 cases reported in the literature. Although HSV hepatitis typically occurs in immunocompromised hosts, pregnancy-especially the third trimester, has been identified as a risk factor for its development. This is likely because of the fact that humoral and cell-mediated immunity decrease throughout pregnancy and nadir in the third trimester with decreased T-cell counts and altered B/T lymphocyte ratios. Here, we report on a patient with HSV 2 hepatitis in a previously healthy 27-year-old woman in her 23rd week of pregnancy. She initially presented with nausea, vomiting, and abdominal pain and was found to have acute hepatocellular liver injury and a systemic inflammatory response syndrome. Broad-spectrum antibiotics and acyclovir were promptly initiated. Liver biopsy, serum DNA polymerase chain reaction (PCR) as well as a labial ulcer culture and PCR were all positive for HSV 2. The patient recovered completely; however, her fetus did not survive. Review of the literature emphasizes that presentation with disseminated HSV infection typically occurs in the third trimester of pregnancy. This report emphasizes that abdominal pain combined with fever and hepatic dysfunction in pregnancy should prompt immediate consideration of the diagnosis of HSV hepatitis. Furthermore, given the high mortality rate and effective treatment, empiric treatment with acyclovir should be considered early in all potential cases.

No MeSH data available.


Related in: MedlinePlus