Trillions and Trillions: Herpes Simplex Virus-1 Hepatitis in an Immunocompetent Adult

Kevin Ikuta; Pavitra Roychoudhury; Hong Xie; Christopher L Mcclurkan; Magdalena Walkiewicz; Negar Makhsous; Meei-Li Huang; Yodit Beru; Mariam Alam; Amanda Shepherd; Eric D Lamotte; Kevin Patel; Amy Morris; Başak Ҫoruh; Lei Yu; Renuka Bhattacharya; Rex Cheng; Roland B Walter; Ajit P Limaye; Christina M Lockwood; Steven M Holland; Robert M Rakita; David M Koelle; Alexander L Greninger

doi:10.1093/ofid/ofz465

Trillions and Trillions: Herpes Simplex Virus-1 Hepatitis in an Immunocompetent Adult

Open Forum Infect Dis. 2019 Nov 5;6(11):ofz465. doi: 10.1093/ofid/ofz465. eCollection 2019 Nov.

Authors

Kevin Ikuta¹, Pavitra Roychoudhury², Hong Xie², Christopher L Mcclurkan¹, Magdalena Walkiewicz³, Negar Makhsous², Meei-Li Huang², Yodit Beru⁴, Mariam Alam⁴, Amanda Shepherd⁴, Eric D Lamotte⁴, Kevin Patel⁵, Amy Morris⁵, Başak Ҫoruh⁵, Lei Yu⁶, Renuka Bhattacharya⁶, Rex Cheng⁶, Roland B Walter⁷, Ajit P Limaye¹, Christina M Lockwood², Steven M Holland³, Robert M Rakita¹, David M Koelle^{1

2

8

9

10}, Alexander L Greninger^{2

9}

Affiliations

¹ Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
² Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
³ Immunopathogenesis Section, National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA.
⁴ Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁵ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁶ Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁷ Clinical Research Division, Fred Hutchinson Cancer Research Center Seattle, Washington, USA.
⁸ Department of Global Health, University of Washington, Seattle, Washington, USA.
⁹ Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
¹⁰ Benaroya Research Institute, Seattle, Washington, USA.

Abstract

We describe a case of acute liver failure and myopericarditis due to herpes simplex virus-1 (HSV-1) in an immunocompetent adult. We estimate that, at the height of viremia, the patient contained a quantity of HSV-1 virions approaching that of human cells. The patient recovered with acyclovir that was dose-adjusted for neurotoxicity and developed a vigorous anti-HSV-1 T-cell response.

Keywords: HSV hepatitis; HSV-1; hepatitis; herpes simplex virus; host response; viral evolution.

Grants and funding

T32 AI007044/AI/NIAID NIH HHS/United States