Primary herpes simplex virus type 1 infection with acute liver failure in solid organ transplantation: Report of three cases and review

Herpes virus infections is not uncommon in solid organ transplantation patients. We report 3 cases with primary Herpes simplex virus type-1 (HSV1) infection with acute liver failure (ALF). This is a rare and potentially fatal entity that could be a donor-derived infection. Although the initial clinical presentation is non-specific, it should be considered as a differential diagnosis in HSV-negative serology patients with liver failure and empirical treatment must be started in combination with a drastic reduction of immunosuppression. A strategy of HSV prophylaxis for pre-transplant HSV seronegative patients must be stablished in order to reduce the risk of clinical disease. •HSV hepatitis is a rare and fatal entity that can be a donor-derived infection.•It should be suspected in highly immunosuppressed transplant patients who develop acute liver failure.•The treatment delay is associated with higher fatality.•In transplant patients with negative HSV serology, prophylaxis is recommended if they are not with prophylaxis for CMV.