Herpes Simplex Virus 1 Hepatitis Leading To Liver Failure And Hemophagocytic Lymphohistiocytosis Case Report And Review Of The Literature

A 65-year-old immunocompetent adult presented with fever, fatigue, and laboratory evidence of acute liver failure. He was unable to undergo liver biopsy secondary to coagulopathy. His herpes simplex virus 1 (HSV-1) polymerase chain reaction level was elevated in the serum, leading to presumptive diagnosis of HSV-1-associated hepatitis. His course was complicated by rising ferritin, and workup revealed hemophagocytic lymphohistiocytosis suspected to be secondary to infection with HSV-1. He improved on intravenous acyclovir and completed a 21-day course. Review of the literature demonstrates that this is the fourth case of hemophagocytic lymphohistiocytosis associated with HSV-1 alone in an immunocompetent adult. Case reports have described treatment regimens including antivirals, antivirals in combination with immunosuppressant agents, and liver transplantation with immunosuppression with successful outcomes.