Illustrated Forensic PathologyDisseminated Herpes Simplex Virus in an Immunocompetent Patient Without Presence of Epidermal or Mucosal LesionsMarshall, Cody DO; Khatoon, Nazia MD; Lynch, Edward MDAuthor Information From the Allegheny Health Network Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA. Manuscript received October 8, 2020; accepted November 3, 2020. The authors report no conflict of interest. Reprints: Cody Marshall, DO, Allegheny Health Network, 320 E North Ave, Pittsburgh, PA 15212. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: June 2021 - Volume 42 - Issue 2 - p e13-e15 doi: 10.1097/PAF.0000000000000652 Buy Metrics Abstract Herpes simplex virus (HSV) is a disease usually characterized by lesions within the epidermis or mucosa of children and adults. However, this infection can also cause complications to many systems of the body, including the peripheral and central nervous system, respiratory system, and hepatobiliary system. In this case, we present a 43-year-old man with a history of substance abuse, who presented with fever, cough, and headache, and within days, progressed into fulminant hepatitis and hypoxic failure. Bacterial and fungal cultures were negative, as well as the workup for human immunodeficiency virus. However, the presence of HSV was detected in a bronchial lavage culture after the patients had expired. This result, along with the findings at autopsy, including viral cytopathic effect in the lung and liver, which were confirmed with immunohistochemical stains for HSV, strongly suggest that the cause of death is from disseminated herpes virus infection with hepatitis and viral pneumonitis. This disseminated infection occurred in an immunocompetent host without any evidence of mucocutaneous lesions. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.