Herpes Hepatitis: Timely Diagnosis Can Be Lifesaving


HONOLULU — The diagnosis of herpes simplex hepatitis in pregnancy is one that simply can't afford to be missed, Dr. Eileen Hay said at the annual meeting of the American College of Gastroenterology.

That's because treatment with acyclovir or vidarabine is lifesaving—and without it, one-half of affected mothers will die of fulminant hepatitis, stressed Dr. Hay, professor of medicine at the Mayo Medical School, Rochester, Minn.

Herpes hepatitis is a rare disorder. In pregnancy, it occurs in the third trimester. It is usually but not always preceded by a flulike viral prodrome. The typical mucocutaneous herpetic lesions aren't always present.

The characteristic features of this infection are the third-trimester presentation, marked elevation of transaminases (with levels often in the thousands) along with coagulopathy, and encephalopathy, but no jaundice.

Liver biopsy shows hepatocytes with the classic viral inclusion bodies of herpes simplex virus.

It's necessary to consider delivery only in the very rare instance where the patient shows no response to antiviral therapy, Dr. Hay said.

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