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HSV Hepatitis in Pregnancy

A Review of the Literature

McCormack, Ashley Lane, BS*; Rabie, Nader, MD; Whittemore, Brianna, MD; Murphy, Trevor, BS§; Sitler, Collin, DO; Magann, Everett, MD

Obstetrical & Gynecological Survey: February 2019 - Volume 74 - Issue 2 - p 93–98
doi: 10.1097/OGX.0000000000000642
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Importance Herpes simplex virus (HSV) hepatitis is a rare condition with a high mortality rate. Immunocompromised individuals, including pregnant women, are the most susceptible. When primary infection occurs during pregnancy, risk for disseminated HSV is greatly increased. Disseminated HSV can manifest in the form of HSV hepatitis.

Objective We aim to review the literature and summarize what is known about HSV hepatitis in pregnancy to aid in the diagnosis and treatment of this condition.

Evidence Acquisition A literature search of PubMed and Web of Science was performed. A total of 237 citations were found. All citations were independently reviewed. Thirty-eight full-text articles were identified and included in this review. Additional data from 1 unpublished case from our institution was included.

Results Fifty-six cases were included with average gestational age at diagnosis of 30 weeks. Patients presented with a wide variety of gastrointestinal, respiratory, neurologic, and urogenital symptoms. The most common examination findings were fever and abdominal tenderness. Only 18.2% of patients had a vesicular rash. All patients had a transaminitis, and 85% had positive viral cultures. A multitude of treatments were used with the majority of favorable outcomes occurring after treatment with acyclovir.

Conclusions and Relevance Although HSV hepatitis is rare, it carries a mortality rate of up to 39% for mothers and neonates. Therefore, it is crucial that HSV hepatitis be included on the differential diagnosis when a patient presents with fever and transaminitis. When HSV hepatitis is suspected, empiric therapy with acyclovir can be initiated with no additional risk to the fetus.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the participant should be better able to (1) develop a reasonable differential diagnosis for hepatitis in pregnancy, including HSV hepatitis; (2) differentiate these etiologies based on common presentations, physical findings, and laboratory values; (3) value the usage of empiric acyclovir therapy in pregnancy-related hepatitis; and (4) counsel patients on safety measures to protect themselves and their unborn children from infection during pregnancy, including avoidance and vaccination.

*Medical Student, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR;

Staff Physician, Tripler Army Medical Center, Honolulu, HI;

Staff Physician, US Naval Hospital Okinawa, Okinawa, Japan;

§Undergraduate Student, Southern Illinois University in Carbondale, Carbondale, IL;

Resident Physician, Tripler Army Medical Center, Honolulu, HI; and

Staff Physician, University of Arkansas for Medical Sciences, Little Rock, AR

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.

The views expressed in this manuscript are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Correspondence requests to: Nader Rabie, MD, Department of OB-GYN, 1 Jarrett White Rd, Honolulu, HI 96859. E-mail: nader.rabie@me.com.

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