Herpes simplex virus sepsis in a young woman with Crohn’s disease.
J Crohns Colitis. 2015 Sep 7;
Authors: Haag LM, Hofmann J, Kredel LI, Holzem C, Kühl AA, Taube ET, Schubert S, Siegmund B, Epple HJ
We present the case of a Herpes simplex virus-1 (HSV-1) sepsis with severe herpes hepatitis in a young female treated with triple immunosuppressive therapy (adalimumab, azathioprine, prednisolone) for refractory Crohn’s disease (CD). The patient presented with high fever, generalized abdominal tenderness, strongly elevated transaminases, coagulopathy, and pancytopenia. Comprehensive diagnostics including blood HSV-1 PCR, liver biopsy, and immunohistochemistry revealed the diagnosis of fulminant herpes hepatitis. HSV-1 positivity of cutaneous lesions proved the disseminated nature of the infection. Early treatment with intravenous acyclovir led to a rapid improvement of the patients’ condition and resulted in a full recovery of her liver function. This is the first reported case of HSV-sepsis in a patient with CD. Physicians treating IBD patients with combined immunosuppressive therapy should be aware of the possibility of herpes hepatitis, and early empiric antiviral therapy should be considered in immunosuppressed patients presenting with fever and severe anicteric hepatitis.
PMID: 26351382 [PubMed – as supplied by publisher]