EC Clinical and Medical Case Reports

Background: Herpes Zoster (HZ), resulting from varicella-zoster virus (VZV) reactivation, typically affects elderly or immunocompromised individuals. Rarely, HZ can cause severe complications like fulminant hepatitis, even in immunocompetent patients. This case highlights the need for awareness of atypical VZV presentations, particularly acute liver failure.

Case Presentation: A 57-year-old immunocompetent male presented with malaise, abdominal pain, gingivorrhagia, and purpuric skin lesions. Initial diagnostics included significant liver enzyme elevation (AST: 4303 U/L, ALT: 2503 U/L, LDH: 19,121 U/L) and thrombocytopenia. Imaging revealed hepatic steatosis, and serologic testing excluded common hepatitis etiologies. Rapid deterioration led to ICU admission and death within hours despite aggressive management. Postmortem liver biopsy confirmed viral hepatitis, suggesting VZV as the likely causative agent.

Discussion: Fulminant hepatic failure from VZV is rare in immunocompetent hosts. The absence of classic HZ rash in initial stages complicates diagnosis, emphasizing the importance of histopathology and clinical suspicion. Prompt antiviral therapy with acyclovir is crucial for favorable outcomes in suspected cases.

Conclusion: This case underscores the importance of considering VZV in acute liver failure cases regardless of immune status. It highlights the critical need for early recognition and treatment to mitigate poor outcomes. Further research is essential to understand VZV's pathogenesis in severe hepatic manifestations.

 Keywords: Fulminant Hepatitis; Varicella-Zoster Virus; Herpes Zoster; Immunocompetent; Liver Failure; Case Report

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