Fatal fulminant herpes simplex hepatitis secondary to tongue piercing in an immunocompetent adult: a case report

INTRODUCTION: Herpes simplex infection is most commonly a benign, self-limiting disease with mucocutaneous lesions and mild viremia. Immunosuppressed patients are at a higher risk of disseminated infection, as are neonates and pregnant women. The incidence of fulminant herpes simplex virus hepatitis is extremely low, and the diagnosis is often missed due to the lack of specific signs or symptoms. CASE PRESENTATION: We present the case of an immunocompetent, previously healthy young woman who contracted herpes simplex virus, presumably through a recent tongue piercing, which progressed to fulminant hepatitis and death. CONCLUSION: Despite aggressive medical therapy, fulminant herpes simplex virus hepatitis is fatal in the majority of patients. We present a review of the literature, which shows that immunocompetent adults have rarely been affected by fulminant herpes simplex virus hepatitis. Initiation of empirical therapy is warranted in patients with progressive hepatic failure with no other underlying cause. Acyclovir therapy has proven effective in some patients, but is less effective in patients who present in advanced stages of infection.