Acute Liver Failure due to Disseminated Varicella Zoster Infection

Table 2

Case reports: nonsurvivors [4–9].

Pt Info	PMH	Symptoms	Treatment	Diagnosis	Liver Biopsy
49 y/o M	ETOH and tobacco abuse, 15 days post radical dissection neck and laryngectomy for SCC larynx	Abdominal pain, fever, restlessness	“Intensive supportive care”	Post mortem via liver analysis	Post mortem: liver VZV DNA +, hepatic necrosis with intranuclear inclusion bodies
47 y/o Japanese M	MM s/p chemo, steroids, 2 stem cell transplants, moderate GVHD and relapse of MM with more chemo and steroids	Generalized fatigue	FFP, platelets	Retrospective VZV PCR + blood and liver analysis	Autopsy: + anti-VZV IgG stain of liver with hepatic necrosis seen
49 y/o M	No PMH except treatment for pharyngotonsillitis 15 days prior with abx and prednisone	Acute retrosternal pain	IV acyclovir, VZV immune globulin, total hepatectomy	Skin cytology c/w herpes family virus & immuno-cytochemistry stain VZV +; blood VZV DNA +	Liver bx: necrosis only; Post mortem liver VZV DNA +
15 y/o M	None	Fever, abdominal pain, myalgia, skin vesicles	IV acyclovir, MARs	Post mortem liver analysis	Post mortem liver analysis: hepatic necrosis, multinucleation and intranuclear inclusions of Cowdry A bodies; liver VZV PCR +
26 y/o CF	Diagnosed with MS 3 months prior and treated with steroids	Abd pain and vomiting	PO acyclovir → IV acyclovir	Blood and urine VZV PCR +; post mortem liver analysis	Post mortem liver: hemorrhagic necrosis and VZV PCR +
64 y/o CF	14 months post-op esophago-gastrectomy & splenectomy	Fever, malaise, HA	Vit K	VZV titers D4: 1-64 → D7: 1-256; liver autopsy analysis	Autopsy liver: hemorrhagic necrosis and signs herpes family virus including Cowdry A intranuclear bodies; EM: intracellular virions consistent with herpes family virus