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271 REPEATED HERPETIC HEPATITIS LEADING TO LIVER FAILURE AND CIRRHOSIS MS Song, P Ghali INTRODUCTION: Herpes simplex virus and Herpes zoster virus are rare causes of fulminant hepatic failure in immunocompromised patients. Survival after disseminated herpes simplex or herpes zoster hepatic failure is low and most case reports are of patients who are post-mortem. Herein we report a case of recurrent hepatic failure secondary to herpes virus proven by PCR following bolus steroid injection.
Department of Gastroenterology, Faculty of Medicine, McGill University, Montreal, Quebec
CASE: A 40 year old female patient was admitted with fulminant hepatic failure secondary to herpes virus after receiving IV pulse Solu-medrol for exacerbation of multiple sclerosis that was resistant to Interferon. Other viral and non-viral causes of acute hepatitis had been excluded. She was listed for liver transplant but improved slowly and survived this acute event without transplant. After the discharge, because of persistently impaired liver function, a biopsy was repeated and showed cirrhosis. She required repeated treatment with IV steroids because of severe multiple sclerosis, so was given prophylactic acyclovir. Despite this, she again developed recurrent fulminant hepatitis secondary to herpes. She recovered slowly without liver transplant after a course of Foscarnet.
CONCLUSION: To our knowledge this is the first case report of cirrhosis developing secondary to herpes hepatitis. This is also the first reported survival following antiviral therapy including Foscarnet after two fulminant hepatic failures. This case demonstrates the importance of vigilant monitoring for viral hepatitis even on prophylaxis and possibility of cirrhosis secondary to virus in herpes family.