Acute Liver Failure Secondary to Herpes Simplex Virus Hepatitis Following Gynecologic Surgery

Herpes simplex virus (HSV) hepatitis is a lethal cause of acute liver failure (ALF). This is likely due to its nonspecific clinical presentation delaying diagnosis. There are a handful of case reports describing HSV hepatitis in pregnancy, but there are no published cases associating HSV hepatitis with gynecologic surgery (GS). We report HSV-associated ALF progressing to death in 2 young patients who are immunocompetent without significant medical comorbid conditions. Both patients had GS preceding their liver injury. This highlights a possible predisposition to HSV hepatitis following GS and suggests heightened clinical suspicion and consideration of empirical acyclovir in patients presenting with ALF following GS.