Ann Liver Transplant.  2021 Nov;1(2):202-206. 10.52604/alt.21.0029.

Fatal systemic herpes simplex virus infection with atypical clinical manifestation early after living donor liver transplantation

• Jo HS
• Park PJ
• Kim WJ
• Han HJ
• Yu YD
• Kim DS

• KMID: 2560873
• DOI: http://doi.org/10.52604/alt.21.0029

Abstract

Herpes simplex virus (HSV) infection in immunocompromised hosts after liver transplantation could cause visceral dissemination and fatal outcomes. Here, we report a fatal systemic HSV infection with atypical clinical presentation early after living donor liver transplantation. A 45-year-old female patient with chronic alcoholic liver cirrhosis underwent living donor liver transplantation using a left liver graft. The patient was clinically stable, and her liver function was recovering without any problems until postoperative day 12. However, mild erythematous erosive patches developed on both palms and soles. Although various topical steroids were applied and antihistamines were administered, the skin lesions gradually spread to the trunk and worsened with severe pain. Several days after the onset of skin lesions, aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels increased rapidly without specific findings on the CT scan. Therefore, we decided to perform skin and liver biopsies. The patient rapidly deteriorated and was transferred to the intensive care unit while awaiting the biopsy results. The biopsies showed very distinctive features compatible with HSV infection. The HSV IgG assay before liver transplantation was positive. Although we administered high-dose intravenous acyclovir immediately after the pathologic diagnosis, the patient died of severe septic shock on postoperative day 28. The possibility of HSV infection should be considered when atypical skin lesions occurring early after liver transplantation do not respond to antihistamines and steroids. An early diagnosis and the prompt administration of antiviral agents could prevent the fatal dissemination of an HSV infection in liver transplantation recipients.

Keyword

Herpes simplex virus; Viral infection; Liver transplantation; Immunosuppression; Opportunistic infections