Fulminant Hepatitis Due to Father-to-Newborn Transmission of Herpes Simplex Virus type 1
A 8-day old male newborn was admitted to the emergency ward for abdominal pain with 39°C fever. Escherichia coli pyelonephritis was laboratory-documented on the urine sample. At this time, except for an elevated inflammatory marker (CRP = 15 mg / l), liver function tests, blood cell count and hemostasis markers were normal. He was transferred to pediatric unit to receive intravenous antibiotics. Eleven days later, his condition suddenly deteriorated with jaundice, abdominal collateral circulation, hepatosplenomegaly, and diarrhea in a febrile context(39.5°C) suggesting splenic hypertension; he was transferred to the neonatal intensive care unit. Biologic analyses showed a severe hepatic failure (prothrombin ratio at 25%, fibrinogen at 0.19g/L) with severe cytolytic hepatitis (AST = 2,720 IU/L, ALT = 1,353 IU/L, normal range = 6-40 IU/L), moderate cholestasis (total bilirubin at 119 µmol/L), severe thrombocytopenia (13g/L) and disseminated intravascular coagulation (fibrin monomer at 50 µg/mL, activated coagulation time at 58 sec). He was transfused with platelet, plasma and fibrinogen units. An empirical treatment by aciclovir was started. Bacterial sepsis was ruled out since blood and CSF cultures were negative. Other conditions such as metabolic disease, macrophage activation syndrome and hemochromatosis were negative (myelogram, iron status). Hepatotropic viruses (hepatitis A-E viruses, Cytomegalovirus, Herpes simplex virus (HSV), varicella-zoster virus, and Epstein-Barr virus) were tested via serology and PCR or RT-PCR-based genome amplification, but were negative except for HSV for which acute serum contained IgM, and HSV PCR was positive in whole blood and in the liver biopsy []. HSV type 1 (HSV-1) infection was confirmed using PCR based typing []. Histologic analysis of the liver biopsy showed a severe disseminated cytolysis. Thorough clinical examination of the patient did not find either mucocutaneous vesicles or encephalitis signs. Before this episode and apart from the pyelonephritis, the first 3 weeks of life were associated with normal weight gain. The treatment by intravenously acyclovir was prolonged during 21 days. The clinical and biological examinations progressively improved and the newborn was discharged after one month.