Herpes simplex virus (HSV)
hepatitis is a rare complication of HSV
infection, and a rare cause of
hepatitis. It is often fatal, especially if the diagnosis and treatment are delayed. Herein, we describe the case of a 31-year-old female with a history of receiving cytotoxic
cancer chemotherapy five months prior who presented with a one-week history of worsening
abdominal pain and
fever. She was noted to have an outbreak of
genital herpes at the time of presentation. Computed tomography (CT) scan of the abdomen showed innumerable hypodensities compatible with hepatic micro-
abscesses. A specimen from a subsequent liver biopsy revealed HSV-type cytopathic changes and nuclear staining with an anti-HSV immunohistochemical
stain. She was initially started on high-dose oral
valacyclovir for
genital herpes and was noted to have rapid clinical improvement prior to the histopathologic diagnosis of HSV
hepatitis. She achieved full recovery while on oral
valacyclovir. This is the first reported case of HSV
hepatitis treated with oral
valacyclovir and the third reported case of HSV
hepatitis mimicking pyogenic
abscesses on abdominal imaging. With the high mortality rate associated with HSV
hepatitis, one should consider the diagnosis in all patients with multifocal liver lesions of unknown etiology, especially if
genital herpes is present at the time of presentation, or in patients who are immunocompromised.