Table 2.
Clinical Findings and Hospital Outcomes in 33 Patients With Proven HSV Hepatitis
| Median [IQR] or No. (%) | |
|---|---|
| Diagnosis | … |
| Positive blood PCR | 33 (100) |
| HSV1 | 12/24 (50) |
| HSV2 | 12/24 (50) |
| N/A (serotype not available) | 9 |
| Viral load (14/33 patients), log DNA copies/mL | 6.5 [5.2–8.0] |
| Liver biopsy obtaineda | 16 (48.5) |
| Negative HSV IgG when available | 16/17 (94.1) |
| Clinical outcome during the stay in intensive care | … |
| Maximum temperature, °C | 39.1 [38.6–40.0] |
| Hepatic encephalopathy | 27 (82) |
| Proven HSV encephalitis | 6 (18) |
| Myocarditis | 4 (12.1) |
| Hemorrhagic shock | 11 (33.3) |
| Hemophagocytic syndromeb | 16 (48.5) |
| HScore (score)c | 176 [104–240] |
| HScore (probability of HS), % | 63 [1.9–98.9] |
| Disseminated intravascular coagulation | 14 (42.4) |
| Antiviral treatment | … |
| Acyclovir initiated | 32 (97) |
| Time from symptom to treatment, d | 8 [5–10.3] |
| ICU admission to treatment, d | 1 [0–3.3] |
| Biological evolution | … |
| AST peak level, IU/L | 7000 [2714–10 000] |
| ALT peak level, IU/L | 2000 [1100–4815] |
| PT nadir, % | 20 [8–35] |
| Nadir factor V, % | 17 [5–31] |
| Hemophagocytosis on myelogram, % | 12 (41) |
| Outcomes | … |
| Mortality in ICU | 23 (69.7) |
| 30-d mortality | 23 (69.7) |
| Liver transplant | 4 (12.1) |
| Successful liver transplant | 0/4 (0) |
Abbreviations: ALT, alanine transaminase; AST, aspartate transaminase; HS, hemophagocytic syndrome; HSV, herpes simplex virus; ICU, intensive care unit; IQR, interquartile range; PT, prothrombin rate.
aDisplaying massive hepatocyte necrosis (n = 16/16), viral inclusions (n = 8/16), and positive HSV immunostaining (n = 15/16).
bAccording to HLH 2004 criteria by Henter et al. [11].
cScore reported by Fardet et al. [12].