Fulminant hepatic and multiple organ failure following acute viral tonsillitis: a case report

Journal of Medical Case Reports

Joerg C. Schefold²  Jukka Takala²  Jean-Francois Dufour³  Sabina Berezowska⁴  Charles Beguelin¹  Ursina Bechtel-Grosch² 

[1] Department of Infectious Diseases, Inselspital, Bern University Hospital, Bern, CH 3010, Switzerland;Department of Intensive Care Medicine, Inselspital, Bern University Hospital, Bern, CH 3010, Switzerland;Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, CH 3010, Switzerland;Institute of Pathology, University of Bern, Bern, CH 3010, Switzerland

关键词: Viral infection;    Septic shock;    Sepsis;    MOF;    Hepatitis;    Critical illness;   

Others  :  1235825
DOI  :  10.1186/s13256-015-0777-3

 received in 2015-03-16, accepted in 2015-11-30,  发布年份 2016

【 摘 要 】

Background

Pyogenic tonsillitis may often be observed in the general Western population. In severe cases, it may require antibiotic treatment or even hospitalization and often a prompt clinical response will be noted. Here we present an unusual case of progressive multiple organ failure including fulminant liver failure following acute tonsillitis initially mistaken for “classic” pyogenic (that is bacterial) tonsillitis.

Case presentation

A 68-year-old previously healthy white man was referred with suspicion of pyogenic angina. After tonsillectomy, he developed acute liver failure and consecutive multiple organ failure including acute hemodynamic, pulmonary and dialysis-dependent renal failure. Immunohistopathological analysis of his tonsils and liver as well as serum polymerase chain reaction analyses revealed herpes simplex virus-2 to be the causative pathogen. Treatment included high-dose acyclovir and multiorgan supportive intensive care therapy. His final outcome was favorable.

Conclusions

Fulminant herpes simplex virus-2-induced multiple organ failure is rarely observed in the Western hemisphere and should be considered a potential diagnosis in patients with tonsillitis and multiple organ failure including acute liver failure. From a clinical perspective, it seems important to note that fulminant herpes simplex virus-2 infection may masquerade as “routine” bacterial severe sepsis/septic shock. This persevering condition should be diagnosed early and treated goal-oriented in order to gain control of this life-threatening condition.

【 授权许可】

   
2016 Bechtel-Grosch et al.

【 图 表 】

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