Fulminant hepatic failure for herpes simplex virus

Although exceedingly rare, fulminant hepatic failure in immunocompetent patients can develop with primary or recurrent infection due to herpes simplex virus. The diagnosis is frequently obscured by the absence of mucocutaneous involvement. Elevated transaminases with leucopenia and a relatively low bilirubin level may provide clues to the diagnosis. Here a female patient, 43 years, presented with the complaints of increasing jaundice, anorexia, nausea, vomiting for one week duration. She had hepatomegaly. Investigations revealed markedly raised transaminases and coagulopathy. Herpes simplex virus IGM (by ELISA) was positive. The immunocompetent woman was treated with acyclovir but the result was fatal.