Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing

Acute liver failure (ALF) is a severe condition in which liver function rapidly deteriorates in individuals without prior history of liver disease. While most cases result from acetaminophen overdose or viral hepatitis, in up to a third of patients, no clear cause can be identified. Liver transplant...

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Main Authors: Atsushi Ono, C. Nelson Hayes, Sakura Akamatsu, Michio Imamura, Hiroshi Aikata, Kazuaki Chayama
Format: Article
Language:English
Published: Wiley 2017-01-01
Series:Case Reports in Hepatology
Online Access:http://dx.doi.org/10.1155/2017/4630621
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author Atsushi Ono
C. Nelson Hayes
Sakura Akamatsu
Michio Imamura
Hiroshi Aikata
Kazuaki Chayama
author_facet Atsushi Ono
C. Nelson Hayes
Sakura Akamatsu
Michio Imamura
Hiroshi Aikata
Kazuaki Chayama
author_sort Atsushi Ono
collection DOAJ
description Acute liver failure (ALF) is a severe condition in which liver function rapidly deteriorates in individuals without prior history of liver disease. While most cases result from acetaminophen overdose or viral hepatitis, in up to a third of patients, no clear cause can be identified. Liver transplantation has greatly reduced mortality among these patients, but 40% of patients recover without liver transplantation. Therefore, there is an urgent need for rapid determination of the etiology of acute liver failure. In this case report, we present a case of herpes simplex 2 virus- (HSV-) associated ALF in an immunocompetent patient. The patient recovered without LT, but the presence of HSV was not suspected at the time, precluding more effective treatment with acyclovir. To determine the etiology, stored blood samples were analyzed using whole transcriptome shotgun sequencing followed by mapping to a panel of viral reference sequences. The presence of HSV-DNA in blood samples at the time of admission was confirmed using real-time polymerase chain reaction, and, at the time of discharge, HSV-DNA levels had decreased by a factor of 106. Conclusions. In ALF cases of undetermined etiology, uncommon causes should be considered, especially those for which an effective treatment is available.
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spelling doaj-art-7da9bcd0fd1441518f4c67f73f108baf2025-08-20T03:35:24ZengWileyCase Reports in Hepatology2090-65872090-65952017-01-01201710.1155/2017/46306214630621Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun SequencingAtsushi Ono0C. Nelson Hayes1Sakura Akamatsu2Michio Imamura3Hiroshi Aikata4Kazuaki Chayama5Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, JapanDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, JapanDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, JapanDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, JapanDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, JapanDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, JapanAcute liver failure (ALF) is a severe condition in which liver function rapidly deteriorates in individuals without prior history of liver disease. While most cases result from acetaminophen overdose or viral hepatitis, in up to a third of patients, no clear cause can be identified. Liver transplantation has greatly reduced mortality among these patients, but 40% of patients recover without liver transplantation. Therefore, there is an urgent need for rapid determination of the etiology of acute liver failure. In this case report, we present a case of herpes simplex 2 virus- (HSV-) associated ALF in an immunocompetent patient. The patient recovered without LT, but the presence of HSV was not suspected at the time, precluding more effective treatment with acyclovir. To determine the etiology, stored blood samples were analyzed using whole transcriptome shotgun sequencing followed by mapping to a panel of viral reference sequences. The presence of HSV-DNA in blood samples at the time of admission was confirmed using real-time polymerase chain reaction, and, at the time of discharge, HSV-DNA levels had decreased by a factor of 106. Conclusions. In ALF cases of undetermined etiology, uncommon causes should be considered, especially those for which an effective treatment is available.http://dx.doi.org/10.1155/2017/4630621
spellingShingle Atsushi Ono
C. Nelson Hayes
Sakura Akamatsu
Michio Imamura
Hiroshi Aikata
Kazuaki Chayama
Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
Case Reports in Hepatology
title Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
title_full Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
title_fullStr Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
title_full_unstemmed Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
title_short Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing
title_sort retrospective identification of herpes simplex 2 virus associated acute liver failure in an immunocompetent patient detected using whole transcriptome shotgun sequencing
url http://dx.doi.org/10.1155/2017/4630621
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