Acute liver failure in the setting of herpes simplex virus and coexistent acute fatty liver of pregnancy

Fulminant hepatitis is a rare complication of herpes simplex virus (HSV-1 and HSV-2). Another rare cause of fulminant hepatitis in pregnant women is acute fatty liver of pregnancy (AFLP). Here we present a female with fulminant hepatitis after a cesarean section whose infant clinically decompensated in the early neonatal period. Mother and child were diagnosed with fulminant hepatic failure from HSV, and the mother was found to have coexistent fatty liver of pregnancy on biopsy. Thus, two rare causes of fulminant hepatitis were co-morbid in the same patient. Rapid diagnosis enabled successful treatment, and both mother and infant recovered well.