Herpes Simplex Virus Hepatitis: A Rare, Oft Overlooked, Potentially Disastrous Cause of Liver Allograft Dysfunction

Despite advancement in surgical techniques, better peri-operative care, and improved potency of immunosuppressive regimens, infections (both de novo and reactivated latent infections) remain a significant cause of morbidity and mortality in liver transplant recipients, with up to 80% of transplant recipients developing at least one episode of infection during the first year following transplantation, including bacterial, viral, fungal, and other infections. Post-transplant herpes simplex virus (HSV) hepatitis is rare, occurs primarily as a reactivation of latent infection, and less commonly as a de novo infection (including donor-derived infection). If not promptly recognized and treated, HSV hepatitis is associated with a high mortality (up to 70% patients). High index of suspicion is needed for accurate diagnosis. We present herein, an account of herpes simplex hepatitis in an adult male patient, which developed shortly after the index patient underwent liver transplantation for decompensated chronic alcoholic liver disease.