Fatal fulminant herpes simplex hepatitis following surgery in an adult

Figure 1 Clinical summary of the patient with herpes simplex hepatitis. Fever and diarrhea emerged accompanied with rapid elevation of liver transaminase and decrease in the numbers of leukocyte and platelets on postoperative day 5. Liver dysfunction was characterized by marked elevation of transaminase levels (aspartate aminotransferase > alanine aminotransferas) with mild increase of total bilirubin levels (Anicteric hepatitis). In upper panel, prothrombin time, platelet count, and white blood cell count were indicated as green-, blue-, and red-line, respectively. In lower panel, the levels of AST, ALT, and total bilirubin, were indicated as red-, blue-, and green-line, respectively. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ACV: Acyclovir; CT: Computed tomography; PT: Prothrombin time; T.bil: Total bilirubin.

Figure 2 Histology of postmortem needle biopsies of the liver. A: Massive hemorrhagic necrosis with minimum inflammatory infiltrates (hematoxylin-eosin stain; original magnification, 200 ×); B: Viral inclusions (arrow) scattered in infected hepatocytes (hematoxylin-eosin stain; original magnification, 200 ×); C: Immunostaining for herpes simplex virus type 1 (original magnification, 200 ×).