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Acute liver failure caused by herpes simplex virus in a pregnant patient: is there a potential role for therapeutic plasma exchange?
- Source :
- Journal of clinical apheresis. 28(6)
- Publication Year :
- 2013
-
Abstract
- A young woman presented with a febrile illness in the third trimester of pregnancy. Laboratory investigation revealed severe acute hepatitis with thrombocytopenia and coagulopathy. Liver injury progressed despite emergent caesarian section and delivery of a healthy infant. Therefore, therapeutic plasma exchange (TPE) was performed on three consecutive days post-partum for a presumed diagnosis of acute liver failure (ALF) associated with pregnancy due to hemolysis, elevated liver enzymes, and low platelets (HELLP) or acute fatty liver of pregnancy (AFLP). Treatment with TPE was followed by biochemical and clinical improvement but during her recovery herpes simplex virus type 2 (HSV-2) infection was diagnosed serologically and confirmed histologically. Changes in the immune system during pregnancy make pregnant patients more susceptible to acute HSV hepatitis, HSV-related ALF, and death. The disease is characterized by massive hepatic inflammation with hepatocyte necrosis, mediated by both direct viral cytotoxicity and the innate humoral immune response. TPE may have a therapeutic role in acute inflammatory disorders such as HSV hepatitis by reducing viral load and attenuating systemic inflammation and liver cell injury. Further investigation is needed to clarify this potential effect. The roles of vigilance, clinical suspicion, and currently accepted therapies are emphasized.
- Subjects :
- Male
Hepatitis, Viral, Human
Hydrocortisone
Plasma Exchange
Cesarean Section
Infant, Newborn
Acyclovir
Herpes Simplex
Puerperal Disorders
Antiviral Agents
Combined Modality Therapy
Dexamethasone
Systemic Inflammatory Response Syndrome
Anti-Bacterial Agents
Pregnancy Complications
Young Adult
Fetal Organ Maturity
Pregnancy
Acute Disease
Humans
Female
Emergencies
Pregnancy Complications, Infectious
Liver Failure
Subjects
Details
- ISSN :
- 10981101
- Volume :
- 28
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of clinical apheresis
- Accession number :
- edsair.pmid..........02e4859c52f01edf8523bc0e9039f789