Fulminant hepatitis following primary herpes simplex virus infection in renal transplant recipients

Abstract EN

Fulminant hepatic failure (FHF) is a rare but well-recognized complication of primary herpes simplex virus (HSV) infection in immunocompromised patients.

Here, we report two cases of acute hepatitis and FHF secondary to primary HSV type 1 infection following renal transplantation in the absence of any mucocutaneous manifestation.

High levels of HSV type-1 DNA were detected in the blood.

Both patients were seronegative for HSV 1 and HSV 2 immunoglobulin G (IgG) before transplantation, whereas the donor of patient 1 was HSV 1 IgG-positive but had no viremia and the donor of patient 2 was HSV-seronegative.

Patient 1 recovered with acyclovir and immunoglobulin whereas patient 2 did not respond and succumbed to death.

HSVseronegative patients are potentially at risk of developing severe primary HSV disease following transplantation, particularly in the absence of routine anti-viral prophylaxis.

HSV infection should always be excluded in transplant patients with hepatic dysfunction.