Fulminant hepatic failure from herpes simplex in pregnancy.

MANY PREGNANCY-SPECIFIC liver disorders occur in the third trimester; thus, an aetiological diagnosis of liver diseases can be difficult. Common liver disorders in pregnancy are intrahepatic cholestasis of pregnancy, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), and acute fatty liver of pregnancy. The commonest cause of jaundice in pregnancy is acute viral hepatitis, which can result from primary infections with hepatitis viruses A to E or as part of a systemic infection with viruses such as cytomegalovirus, Epstein–Barr virus, varicella zoster virus and herpes simplex virus (HSV).1 Except when caused by hepatitis E virus or HSV, viral hepatitis does not usually increase maternal or fetal mortality.2 Hepatitis due to HSV infection is a rare but frequently fulminant disease. Most reports have been in immunocompromised patients3 or newborns.4 Fulminant HSV hepatitis has been reported in immunocompetent adults,5-7 mostly pregnant women.8-10 Two per cent of susceptible women acquire HSV infection during pregnancy, and seroconversion can be asymptomatic.6 Fulminant hepatic failure from herpes simplex in pregnancy