Fulminant hepatitis due to Herpes Simplex Virus-type 2 in early phase of bone marrow transplantation

Hepatitis due to Herpes Simplex Virus (HSV) is a rare and severe infection in patients with impaired immunity, as bone marrow transplanted. The antemortem diagnosis is often difficult to establish because the clinical features are nonspecific. We report an uncommon cause of fulminant hepatic failure in a neutropenic patient, 14 days after bone marrow transplantation. HSV-2 fulminant hepatitis occured during acyclovir prophylactic treatment. No observation of HSV hepatitis in this context has been reported since prohylaxis is used. Because of the extremely high apparent mortality associated with HSV hepatitis, and the improved survival noted among the non-marrow-transplant recipients and prolonged survival seen in one marrow transplant recipient, it seems reasonnable to urge early and aggressively acyclovir therapy. A liver biopsy seems to be indispensable in the case of hepatic failure in post-marrow-transplantation in order to make rapidly a diagnosis.