Atypical case of syphilitic hepatitis

2021 ◽  
Vol 14 (3) ◽  
pp. e237851
Author(s):  
Elliott Goldberg ◽  
Bathai Edwards ◽  
Kaleigh Krill
Keyword(s):  
Abdominal Pain ◽  
Herpes Simplex ◽  
Antinuclear Antibodies ◽  
Maculopapular Rash ◽  
Antimitochondrial Antibodies ◽  
Atypical Case ◽  
Intravenous Acyclovir ◽  
Simplex Virus ◽  
Elevated Transaminases ◽  
Scleral Icterus

A 31-year-old immunocompetent, heterosexual man with no relevant medical history presented with 1 week of jaundice, abdominal pain, cough and headache. Examination revealed scleral icterus, right upper quadrant tenderness and hepatomegaly. Initial investigations revealed hyperbilirubinaemia and elevated transaminases. Serum studies were positive for antinuclear antibodies, antimitochondrial antibodies, and herpes simplex virus IgM. Despite being started on intravenous acyclovir, his bilirubin and transaminase levels continued to rise. He was subsequently tested for syphilis given his maculopapular rash on the soles of his feet and it returned positive. He improved clinically with the initiation of penicillin. In this case, we will discuss the presentation, diagnosis and treatment of syphilitic hepatitis.

Herpes encephalitis and hepatitis in pregnancy: A case report and literature review

2020 ◽  
pp. 1753495X2097803
Author(s):  
Claire M McCarthy ◽  
Caroline Conlon ◽  
Maria Kennelly ◽  
Richard Drew ◽  
Stephen Stewart ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Male Infant ◽  
Herpes Encephalitis ◽  
Intravenous Acyclovir ◽  
Simplex Virus ◽  
Herpes Simplex Virus 2 ◽  
Elevated Transaminases ◽  
Work Up ◽  
In Pregnancy

We present the case of a healthy nulliparous woman who presented with persistent fever, proteinuria and elevated transaminases at 33 weeks’ gestation. Following initial treatment for suspected chorioamnionitis and potential pre-eclampsia, she had a caesarean section delivering a healthy male infant. However, on her third post-operative day, she developed neurological symptoms and accompanying severe sepsis, necessitating inotropic support and transfer to a higher level of care. A comprehensive work-up revealed Herpes Simplex Virus-2 (HSV-2) in serum and cerebrospinal fluid. Abdominal imaging was suggestive of accompanying hepatitis with micro-abscesses. This lady recovered well following intravenous acyclovir for 14 days. Her infant was not affected and was discharged home with his mother. Herpes simplex encephalitis and hepatitis associated with HSV-2 have been described three times previously in pregnancy. We delineate the diagnostic challenges that rare conditions such as this pose and emphasise the importance of multi-disciplinary care in managing complicated medical conditions in pregnancy.

Herpes Simplex Virus Infections

1996 ◽  
Vol 17 (12) ◽  
pp. 415-423
Author(s):  
Paula W. Annunziato
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Hepatitis B Surface Antigen ◽  
Liver Function Tests ◽  
Virus Infections ◽  
Sexually Transmitted ◽  
The Third ◽  
Intravenous Acyclovir ◽  
History Of ◽  
Simplex Virus

Case Report A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).

scholarly journals Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Carrie Down ◽  
Amit Mehta ◽  
Gayle Salama ◽  
Erika Hissong ◽  
Russell Rosenblatt ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Rare Complication ◽  
Unknown Etiology ◽  
Histologic Diagnosis ◽  
Intravenous Acyclovir ◽  
Rim Enhancement ◽  
Magnetic Resonance Imaging Mri ◽  
Hepatic Lesions ◽  
Simplex Virus

Herpes simplex virus (HSV) hepatitis represents a rare complication of HSV infection, which can progress to acute liver failure and, in some cases, death. We describe an immunocompetent 67-year-old male who presented with one week of fever and abdominal pain. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen showed multiple bilobar hepatic lesions, some with rim enhancement, compatible with liver abscesses. Subsequent liver biopsy, however, revealed hepatocellular necrosis, HSV-type intranuclear inclusions, and immunostaining positive for herpes virus type 2 (HSV-2). Though initially treated with broad-spectrum antibiotics, following histologic diagnosis of HSV hepatitis, the patient was transitioned to intravenous acyclovir for four weeks and he achieved full clinical recovery. Given its high mortality and nonspecific presentation, one should consider HSV hepatitis in all patients with acute hepatitis with multifocal hepatic lesions of unknown etiology. Of special note, this is only the second reported case of HSV liver lesions mimicking pyogenic abscesses on CT and MRI.

scholarly journals Herpes Simplex Encephalitis

2005 ◽  
Vol 32 (2) ◽  
pp. 246-247 ◽  
Author(s):  
Sean W. Taylor ◽  
Roger M. Smith ◽  
Giovanna Pari ◽  
Wendy Wobeser ◽  
John P. Rossiter ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Brain Biopsy ◽  
Executive Dysfunction ◽  
Cortical Lesion ◽  
Low Density ◽  
Intravenous Acyclovir ◽  
History Of ◽  
Simplex Virus ◽  
The Right

A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.

scholarly journals Role of Intravenous Acyclovir in Treatment of Herpes Simplex Virus Stromal Keratitis with Ulceration: A Review of 2 Cases

2021 ◽  
Vol 22 ◽  
Author(s):  
Punyanuch Pisitpayat ◽  
Passara Jongkhajornpong ◽  
Kaevalin Lekhanont ◽  
Manachai Nonpassopon
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Intravenous Acyclovir ◽  
Stromal Keratitis ◽  
Simplex Virus

scholarly journals Acute retinal necrosis in a patient with remote severe herpes simplex encephalitis

2019 ◽  
Vol 12 (5) ◽  
pp. e229137 ◽  
Author(s):  
Takaaki Kobayashi ◽  
Poorani Sekar ◽  
Jeffery Meier ◽  
Judy Streit
Keyword(s):  
Herpes Simplex ◽  
Visual Loss ◽  
Acute Onset ◽  
Acute Retinal Necrosis ◽  
High Dose ◽  
Acute Visual Loss ◽  
Intravenous Acyclovir ◽  
Dose Oral ◽  
Simplex Virus ◽  
Hsv 1

A 60-year-old man with a history of severe herpes simplex virus type 1 (HSV-1) encephalitis 2 years prior presented with acute onset of visual loss in the left eye. Dilated funduscopic examination showed retinitis and occlusive vasculitis with retinal necrosis. PCR of the vitreous fluid was positive for HSV-1, and he was diagnosed with acute retinal necrosis (ARN) due to HSV-1. The patient was treated with intravenous acyclovir and intravitreous foscarnet for 2 weeks, followed by high dose oral valacyclovir for 2 weeks. He was subsequently placed on planned life-long suppressive valacyclovir. His case demonstrates that acute visual loss concomitant with or subsequent to HSV-1 encephalitis warrants suspicion of ARN. Prompt therapy with effective antiviral medication is necessary to reduce the risk of sight-threatening complications. Chronic suppression with oral antiviral therapy after ARN is recommended to prevent involvement of the contralateral eye, though there is no consensus on the duration and dosage of antivirals.

scholarly journals Herpes Simplex Virus Type II Infection of Ileum Mesothelium: A Case Report and Review of the Literature

2005 ◽  
Vol 19 (6) ◽  
pp. 367-371 ◽  
Author(s):  
SAC Medlicott ◽  
VG Falck ◽  
KB Laupland ◽  
M Akbari ◽  
PL Beck
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Type I Diabetes ◽  
Type I ◽  
Intravenous Acyclovir ◽  
Direct Fluorescence ◽  
Simplex Virus ◽  
Adhesive Band ◽  
Epithelial Atypia

Disseminated herpes simplex virus (HSV) infection usually manifests in the immunocompromised. However, anecdotal examples of visceral HSV disease and viremia have complicated type I diabetes. A case of a 53-year-old type I diabetic patient with bowel obstruction one week subsequent to bronchitis is reported. At laparotomy, a perforated segment of ileum was associated with an adhesive peritoneal band. HSV cytopathic atypia and HSV immunohistochemical staining were confined to fibrocytes and mesothelial cells without involvement of the epithelium. Dissemination of symptomatic HSV pneumonia was verified by histology, immunohistochemistry, in situ hybridization, polymerase chain reaction and direct fluorescence antibody. Intravenous acyclovir resolved symptoms. This is a novel documentation of HSV complicating ileal adhesive band disease. Furthermore, this case indicates that the HSV cytopathic effect is not unique to the epithelium. Disseminated infection can manifest in myofibrocytes and mesothelium, distinguishing it from standard epithelial atypia of localized HSV infection.

Anti-N-Methyl-D-Aspartate receptor Encephalitis as a potential cause of worsening Herpes Simplex Virus Encephalitis.

2020 ◽  
pp. 1-3
Author(s):  
Saeed Arif ◽  
Shaheer Arif ◽  
Admin
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Neuronal Cell ◽  
Autoimmune Encephalitis ◽  
Herpes Simplex Virus Encephalitis ◽  
Virus Encephalitis ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Intravenous Acyclovir ◽  
Simplex Virus

Madam,Herpes Simplex Virus Encephalitis (HSVE) though rare tends to be lethal if acquired without treatment. The mortality of untreated HSE is up to 70% (1) and most patients don’t return to normal function (1). That said with prompt recognition and treatment with antiviral therapy the prognosis is considerably better (1). HSVE may become complicated by the presence of autoimmune encephalitis particularly Anti-N-Methyl-D-Aspartate receptor Encephalitis (NMDAR) (2). When this occurs the differentiation between two is not possible clinically and radiologically. In such situations the understanding and awareness of autoimmune encephalitis profile which also includes test for NMDAR antibodies becomes very important. Although such expensive tests have become available in Pakistan but the facility is present at only a hand full of centers along with unawareness of this possible condition making the situation worse. We encountered such a situation with our 60-years-old patient who initially presented with altered behaviour and recurrent episodes of focal seizures of left arm with secondary tonic clonic generalization. He was subsequently diagnosed with HSVE on cerebrospinal fluid (CSF) HSV polymerase chain reaction (PCR) and was treated with intravenous acyclovir. Magnetic resonance imaging of the patient showed lesions in the insular cortex, hippocampus, medial frontal lobes and temporal lobes bilaterally (Figure 1). The patient had resolution of symptoms with relapse of altered behaviour eight weeks later. On CSF PCR for HSV this time was negative, with positive serum Anti-N-Methyl-D-Aspartate receptor (NMDAR) antibodies. This condition was treated with plasmapharesis and intravenous methylprednisolone without acyclovir.HSV has been postulated to induce autoimmunity against neuronal cell proteins (3, 4). Moreover, NMDAR Encephalitis has also been described in the literature as an etiology of “Relapsing Post-HSVE”, which is amenable to immune modulation if diagnosed and treated timely. Although one of the considered differential diagnosis in cases of relapse of HSVE, at the same time, NMDAR Encephalitis can also be a reason of worsening or lack of improvement of patients suffering from HSVE (1,2). These clinical situations may be missed by clinicians. So, it is important to differentiate among these clinical situations timely, which can be done easily by the antibody tests. This is important because the direction of therapy changes with initiation of immunotherapy if anti-NMDAR antibodies are tested positive. This may result in improvement in a large subset of patients (5).Continuous...

Sign in / Sign up

Export Citation Format

Share Document