SHM Converge Scientific Abstract ePoster Gallery-Rush to De-Liver: A Case of HSV Hepatitis in Pregnancy

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This case report describes a rare but fatal instance of herpes simplex virus (HSV) hepatitis in pregnancy. A 24-year-old woman at 23 weeks’ gestation initially presented with fever and fatigue and was treated symptomatically, but returned two weeks later with encephalopathy, severe liver failure, and thrombocytopenia. Her condition rapidly worsened, requiring intubation, vasopressor support, and induction of labor, which resulted in fetal loss. She was started on Molecular Adsorbent Recirculating System (MARS) dialysis and underwent extensive testing, including an HSV panel that was positive for HSV-1. Acyclovir was initiated, and she showed temporary improvement in liver enzymes and viral load, allowing extubation.<br /><br />Despite this initial recovery, the patient later developed jaundice, ascites complicated by spontaneous bacterial peritonitis, and recurrent encephalopathy that did not respond to lactulose and rifaximin. Even with continued acyclovir, broad-spectrum antibiotics, and prior MARS therapy, her liver function deteriorated again, leading to multiorgan failure, reintubation, and death from disseminated HSV.<br /><br />The report emphasizes that HSV hepatitis is uncommon but highly lethal, especially in pregnant patients, where mortality can be as high as 75%. Early recognition is critical because initial symptoms may be nonspecific, such as fever and fatigue, and can be mistaken for benign illness. Delayed diagnosis may allow progression to fulminant hepatic failure, encephalopathy, and death. The authors conclude that HSV should be considered in pregnant patients with evolving hepatic injury, and early antiviral treatment may improve outcomes.

Asset Subtitle

Dylan Lopez

Meta Tag

Author List Ariella Azimi, Divya Naik, Dylan Lopez, Hywel Soney, Julie Alexander

Category Clinical Vignettes

Concept Herpes Simplex Virus Hepatitis

Concept Acute Liver Failure

Concept Herpes Simplex Virus Infection

Concept Acyclovir

Concept Pregnancy

Distinguished Non-Finalist

Presenter Organization Methodist Health Systems of Dallas

Presenting Author Dylan Lopez

Track Adult

Keywords

herpes simplex virus

HSV hepatitis

pregnancy

fulminant hepatic failure

encephalopathy

thrombocytopenia

acyclovir

MARS dialysis

spontaneous bacterial peritonitis

disseminated HSV

Herpes Simplex Virus Hepatitis

Acute Liver Failure

Herpes Simplex Virus Infection

Acyclovir

Pregnancy