Liver and intrahepatic bile ducts - nontumor
Viral hepatitis
Herpes simplex virus hepatitis

Topic Completed: 1 May 2012

Revised: 23 January 2019, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Herpes simplex virus hepatitis[TIAB]

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Cite this page: Arora K. Herpes simplex virus hepatitis. website. Accessed April 24th, 2019.
Definition / general
  • Uncommon complication of adult HSV1 or HSV2 infection
  • Usually pregnant women (mean 31 weeks) or immunocompromised patients
  • Often clinically unsuspected (Liver Transpl 2007;13:1428)
  • Rapid downhill course with acute liver failure, usually fatal (up to 81% of adults) due to massive hepatic necrosis (Clin Transplant 2009;23:37), even with rapid antiviral therapy or liver transplanation (Liver Transpl 2008;14:1498)
  • Often not diagnosed until autopsy due to nonspecific clinical features
  • Better survival in children than adults (J Hepatol 2011;55:1222)
  • Sudden, marked elevation of ALT or AST, fever, leukopenia
Case reports
Microscopic (histologic) description
  • May have random areas of bland coagulative necrosis with minimal inflammatory response
  • Hepatocytes may have multinucleated forms
  • At edge of necrotic areas, cells contain intranuclear inclusion surrounded by clear halo with peripheral chromatin margination (eosinophilic Cowdry type A inclusion and basophilic Cowdry type B), with ground glass nuclei
  • Intranuclear inclusions highlighted with Feulgen stain
  • Specific immunostain is available
Microscopic (histologic) images

Images hosted on other servers:

Fulminant hepatic failure

Fulminant hepatic failure during pregnancy (H&E, HSV immunostain)

Necrotic foci, multinucleation, inclusions

Neonatal infection, necrosis with inclusions

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