From Coronavirus Disease 2019 to Herpes Simplex Virus Hepatitis: A Case Report of Complications Linked to Immunosuppressive Therapy

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to severe pneumonia and systemic deterioration in humans. When antiviral drugs and antibodies are not available, it is preferable to choose early treatment methods to suppress cytokine storms. While an interleukin-6 receptor antagonist has proven effective in controlling cytokine storms in coronavirus disease 2019 (COVID-19) pneumonia, it can also increase susceptibility to secondary infections, such as herpes simplex virus (HSV). HSV hepatitis can progress rapidly and be fatal, posing a significant therapeutic challenge. We present the case of a patient with chronic liver disease who developed severe hepatitis following a COVID-19 infection. Despite initial clinical improvement, the patient experienced a relapse marked by high fever, mucosal ulcerations, and deteriorating liver function, eventually leading to acute liver failure and death. Histopathological analysis confirmed HSV hepatitis as the cause of the liver damage. This case underscores the risks associated with HSV reactivation in immunosuppressed patients and highlights the necessity for prompt antiviral treatment and preventive measures. Continuous vigilance is crucial for managing prolonged immunosuppressive states to mitigate severe complications and enhance patient outcomes.