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Clinical pearl: An unusual presentation of HSV : Emergency Medicine News


herpes simplex virus, hepatitis, pregnancy


Hepatitis is a manifestation of disseminated herpes simplex virus (HSV) infection, often reported in pregnant women who acquire HSV during pregnancy.

Pregnant women in any trimester may have fever and hepatitis (markedly elevated transaminases), but may not have genital or skin lesions. HSV hepatitis is associated with fulminant hepatic failure and high mortality (25%).

A high index of suspicion for HSV is required, with confirmatory diagnosis by PCR HSV from blood. Disseminated HSV infection should be considered in pregnant women with fever and severe unexplained hepatitis, and empiric IV acyclovir should be initiated pending confirmation. (MMWR Recommended Representative. 2021;70[4]:1;; J Matern Fetal Neonatal Med. 2020;33[10]:1774; Fixed unsolvable rare issues. 2017;6:124;

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