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Case Reports in Hepatology
Volume 2016 (2016), Article ID 8348172, 5 pages
http://dx.doi.org/10.1155/2016/8348172
Case Report

Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

1Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
2Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
3Department of Pathology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
4Division of Gastroenterology & Hepatology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10021, USA
5Division of Infectious Disease, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 100021, USA

Received 14 July 2016; Accepted 19 September 2016

Academic Editor: Melanie Deutsch

Copyright © 2016 Carrie Down et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Herpes simplex virus (HSV) hepatitis represents a rare complication of HSV infection, which can progress to acute liver failure and, in some cases, death. We describe an immunocompetent 67-year-old male who presented with one week of fever and abdominal pain. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen showed multiple bilobar hepatic lesions, some with rim enhancement, compatible with liver abscesses. Subsequent liver biopsy, however, revealed hepatocellular necrosis, HSV-type intranuclear inclusions, and immunostaining positive for herpes virus type 2 (HSV-2). Though initially treated with broad-spectrum antibiotics, following histologic diagnosis of HSV hepatitis, the patient was transitioned to intravenous acyclovir for four weeks and he achieved full clinical recovery. Given its high mortality and nonspecific presentation, one should consider HSV hepatitis in all patients with acute hepatitis with multifocal hepatic lesions of unknown etiology. Of special note, this is only the second reported case of HSV liver lesions mimicking pyogenic abscesses on CT and MRI.