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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Herpes simplex virus hepatitis

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 10 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.


● 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 (Transplant Proc 2005;37:4393), 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)

Case reports

● Low birth weight newborn with disseminated infection (Arch Pathol Lab Med 2000;124:469)


● Sudden, marked elevation of ALT or AST, fever, leukopenia

Micro 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

Gross/Micro images

Fulminant hepatic failure

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

Necrotic foci, multinucleation, inclusions

Neonatal infection, necrosis with inclusions

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

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