Treatment of Acute Liver Failure with Suspected Herpes Simplex Virus (HSV) or Varicella Zoster Virus (VZV) Infection
Viral herpetic infections are a rare but critical cause of acute liver failure. When HSV or VZV is suspected in a patient presenting with ALF, prompt recognition and specific antiviral management are essential.
Clinical Scenario
This protocol applies to patients with acute liver failure (ALF) in whom herpes simplex virus (HSV) or varicella zoster virus (VZV) infection is suspected. In the setting of ALF with grade 2 encephalopathy and clinical features suggestive of herpetic or zoster infection, empiric antiviral therapy is recommended while confirmatory viral PCR testing is obtained.
Treatment Approach Partial Preview
Intravenous antiviral therapy is the cornerstone of management in this setting. The protocol includes a specific IV antiviral agent — full details of agent selection, sequencing, and clinical decision points are available in the complete protocol.
References
DOI: 10.14309/ajg.0000000000002340
In patients presenting with ALF, grade 2 encephalopathy and features suggestive of HSV or zoster infection, we suggest empiric treatment with IV acyclovir until confirmatory testing with viral PCR is obtained.
In those cases, IV foscarnet is a viable alternative.
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