Herpes simplex virus sepsis and acute liver failure

Acute liver failure is a life threatening disease mostly triggered by drug-induced or toxic liver damage or viral hepatitis. Herpes Simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures. The importance of HSV-induced acute fiver failure is based oil its extremely severe clinical course with lethality rates of almost 75%. HSV hepatitis is just one or several clinical manifestations of HSV sepsis leading more frequently to encephalitis, pneumonia and esophagitis. Local herpes infection or recurrence of dermal lesions (herpes labialis, herpes genitalis), however, is common and account for the high prevalence of HSV-1 or HSV-2 infection in adults. Another rare entity is visual dissemination, which mostly affects immunocompromised patients. Compromised cellular immunity IS 1 Major risk factor for HSV sepsis because of either primary infection or reactivation of occult chronic HSV infection. Delayed diagnosis without antiviral therapy significantly contributes to the unfavorable outcome. Typically, anicteric hepatitis is seen in patients with HSV hepatitis. Because Or its low incidence, however, and the lack of dermal manifestations,, HSV hepatitis is rarely considered in the context of acute liver failure. In addition, diagnostic tests might not always be available. Therefore, it is a generally accepted Consensus to begin antiviral therapy pre-emptively with acyclovir ill cases of acute liver failure of unknown origin, ill which high urgency (HU) liver transplantation remains the only therapeutical option. Even ill the case of early specific therapy. sepsis may prevail and the indication for HU transplantation Must be evaluated carefully. The outcome after liver transplantation for HSV-induced liver failure with reported survival rates of more than 40% is good. Because of file risk of recurrence. lifelong prophylaxis with acyclovir is recommended.