Herpes Simplex Virus Hepatitis in Infants: Clinical Outcomes and Correlates of Disease Severity

Objective To better characterize the clinical outcomes of infants with herpes simplex virus (HSV) infection and identify useful correlates of disease severity. Study design Infants aged ≤6 months with HSV infection treated between 1999 and 2009 were identified. In patients with concurrent hepatitis, laboratory and clinical variables were examined to identify predictors of specific outcomes, including death or the need for liver transplantation and the need for intensive care. Results Of the 15 patients enrolled, 4 (27%) had fatal disease and 2 (13%) required liver transplantation. Infants who lacked skin lesions ( P = .04), had a positive HSV polymerase chain reaction result ( P = .01), had more severe thrombocytopenia ( P = .001), or had other organ system dysfunction ( P = .002) were more likely to require intensive care. A higher International Normalized Ratio value ( P = .001) and peak total bilirubin level ( P = .0002) were predictive of death or the need for liver transplantation. Peak direct bilirubin level was predictive of the need for intensive care and of death or the need for liver transplantation ( P = .04 and .009, respectively). Conclusions HSV hepatitis represents a broad spectrum of disease from mild aminotransferase elevation to fulminant liver failure and death. HSV DNA detected by polymerase chain reaction, a lack of skin lesions, and the degree of coagulopathy, thrombocytopenia, and cholestasis portend unfavorable outcomes.