Abstract
Background Herpes simplex virus (HSV) infection carries one of the poorest outcomes of neonatal
liver failure (NLF). Neonates with disseminated HSV infection can develop hemophagocytic
lymphohistiocytosis (HLH), and occasionally need orthotopic liver transplantation.
Early interventions may be critical for the cure of NLF.
Case Report We describe herewith a 6-day-old neonate with fulminant hepatic failure due to disseminated
HSV-1 infection, who successfully responded to high-dose corticosteroid therapy 72
hours after the onset of disease. Preceding acyclovir, gamma globulin, and exchange
blood transfusion therapies failed to control the disease. Methylprednisolone pulse
therapy led to a drastic improvement of liver function and cytokine storms, and prevented
the disease progression to HLH. Sustained levels of plasma and cerebrospinal fluid
HSV DNA declined after prolonged acyclovir therapy. Bilateral lesions of the periventricular
white matter areas, assessed by magnetic resonance imaging, disappeared at 3 months
of age. The infant showed normal growth and development at 4 years of age.
Conclusion Early anti-hypercytokinemia therapy using corticosteroid, and prolonged antiviral
therapy might only provide the transplantation-free cure of NLF with HSV dissemination.
Keywords
fulminant liver failure - newborn - herpes simplex virus - acyclovir - methylprednisolone
pulse therapy
