SHM Converge Scientific Abstract ePoster Gallery-Disseminated HSV Type-Ii in Immunocompetent Host Presenting With Transaminitis and Back Lesions Without Notable Genital Involvement

Disseminated HSV Type-Ii in Immunocompetent Host Presenting With Transaminitis and Back Lesions Without Notable Genital Involvement

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This case report describes a rare disseminated HSV-2 infection in a 96-year-old immunocompetent man who presented with garbled speech, gait instability, and right-sided weakness, initially concerning for recurrent stroke. Brain imaging showed no new infarct, but laboratory testing revealed marked transaminitis (AST 326, ALT 303). An evaluation for liver injury included hepatitis serologies and other workup, and HSV/VZV IgM returned positive. Physical examination identified painful ulcer-like papulopustular lesions across the back, though he had no notable genital involvement.<br /><br />A positive HSV-2 PCR confirmed disseminated HSV-2 infection, with suspected HSV hepatitis and encephalopathy. He was treated promptly with intravenous acyclovir, then transitioned to oral valacyclovir for two weeks.<br /><br />The report emphasizes that disseminated HSV-2 is uncommon, especially in immunocompetent hosts, and may present with nonspecific findings such as elevated liver enzymes, altered mental status, and neurologic deficits rather than classic genital lesions. Because HSV hepatitis carries very high mortality if untreated, early recognition is essential. The authors highlight that unexplained transaminitis plus skin lesions should prompt consideration of systemic HSV infection, even in elderly patients without overt immunosuppression.

Asset Subtitle

Bolatito P. Balogun

Meta Tag

Author List Asma Khursheed, Bolatito P. Balogun, Brieanna Jung, Maqdous Awan, Woolim Han

Category Clinical Vignettes

Concept HSV-2 Infection

Concept Intravenous Acyclovir

Concept Aminotransferase Elevation

Concept Herpes Simplex Virus Hepatitis

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization Penn State College of Medicine

Presenting Author Bolatito P. Balogun

Track Adult

Keywords

disseminated HSV-2 infection

immunocompetent elderly

HSV hepatitis

transaminitis

encephalopathy

neurologic deficits

skin lesions

positive HSV-2 PCR

intravenous acyclovir

valacyclovir

HSV-2 Infection

Intravenous Acyclovir

Aminotransferase Elevation

Herpes Simplex Virus Hepatitis

Altered Mental Status