P1091 - Unusually Mild Case of Herpes Simplex Virus Hepatitis in a Postpartum Patient

Alaa Taha, MD¹, Iana Gueorguieva, MD², Alan Cutler, MD^2
1Wayne State University/Ascension Providence Rochester Hospital, Rochester, MI; ²Michigan State University/Ascension Providence - Providence Park Hospital, Southfield, MI

Introduction: Herpes simplex virus (HSV) hepatitis is a rare cause of hepatitis which can lead to severe complications including acute liver failure and death if not treated promptly. It is the cause of less than 2% of all viral causes of acute liver failure. Symptoms include fever, headache, nausea and vomiting, right upper quadrant pain, and altered mental status associated with transaminitis in the 1000-fold. HSV hepatitis is mostly seen in immunosuppressed patients or females in the second and third trimester of pregnancy. We present a case of a mild HSV-1 hepatitis in a three month postpartum patient.

Case Description/Methods: A 35-year-old female with recent pregnancy complicated by preeclampsia with severe features presented to the hospital for self-limited epigastric pain. On admission, incidentally she was found to have elevated transaminases with normal bilirubin. Within 4 hours of admission, AST and ALT doubled, and continued to uptrend the following days and peaked at AST 891 unit/L, ALT 450 unit/L. Abdominal ultrasound was negative for biliary etiology. Doppler ultrasound showed a patent portal and splenic vein. Overall INR, platelet count and albumin levels remained normal. Vitals were stable throughout the hospitalization. She denied any herbal substances, significant alcohol use, or drug use. Her only home medication was Labetalol due to preeclampsia. She was started on N–acetylcysteine. Liver workup concluded negative autoimmune, varicella, mononucleosis, and hepatitis A, B and C serology. Upon further investigation, she was found to have positive HSV-1 antibodies which was confirmed with PCR study and diagnosis was established of mild herpes hepatitis given other negative workup. The patient was started on IV Acyclovir. Her AST and ALT levels overall trended down. She was then discharged home on oral Valacyclovir.

Discussion: HSV hepatitis is a rare complication of HSV virus infection and is often described in literature as fulminant liver failure. The diagnosis can be difficult given the lack of specific signs or symptoms, and the lack of quick turnaround of serological testing. Studies show that early diagnosis and treatment with Acyclovir can significantly improve outcome and lower mortality. A high index of suspicion is required especially in patients with acute unexplained elevation in liver enzymes. It is unclear if the patient's recent pregnancy played a role in provoking this complication. However, she fortunately ended up having a benign course of a usually aggressive disease.


Disclosures:


Alaa Taha, MD¹, Iana Gueorguieva, MD², Alan Cutler, MD². P1091 - Unusually Mild Case of Herpes Simplex Virus Hepatitis in a Postpartum Patient, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.