• Sebastián M Chávez, Jaime M Poniachik, Álvaro M Urzua, Juan P Roblero, Máximo J Cattaneo, Andrea P Jimenez, Laura E Carreño, and Rodrigo A Cornejo.
• Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile.
• Medicine (Baltimore). 2021 Sep 3; 100 (35): e27139e27139.

IntroductionAcute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported.Patient ConcernsA 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function.DiagnosisALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood.InterventionsEmpiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated.OutcomesAfter 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation.ConclusionsALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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