Hepatitis, Meningitis and Hydrocephalus Caused by Herpes Simplex Virus Type I

Herpes simplex virus type is the most frequent cause of sporadic and severe encephalitis in western countries. We report the exceptional case of an immunocompetent man aged 51 and who presented with hepatitis and meningitis by herpes simplex virus. Encephalitis responded to acyclovir but hepatitis did not. The patient developed diffuse hydrocephalus that required the appropriate shunt 20 days after being asymptomatic. Several aspects deserve discussion: the clinical onset with meningeal syndrome, the value of the PCR technique for diagnosis and follow-up purposes, the magnetic resonance (MRI) findings, the anicteric hepatitis with reversible cytolysis and persistent coagulation deficit and the hydrocephalus that was due not to direct effect of the virus but to a probable immunological mechanism.