PMC5966627_01
Post mortem diagnosis of HSV hepatitis in liver biopsy sections of case 1.. A) A photomicrograph of a Hematoxylin and Eosin section (20x) of the post mortem liver biopsy performed in case 1. The biopsy reveals necrosis of hepatic parenchyma in the upper left corner and marked fatty changes in the lower right corner. A bi-nucleated hepatocyte with intra-nuclear smudged inclusion is indicated by a red arrow. B) A photomicrograph (20x) of a liver biopsy section immunostained for HSV 1 displays positive nuclear staining in one of the inclusion bodies indicated by a red arrow.
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fig0005
Two types of intra-nuclear inclusions were noted, acidophilic and basophilic (Fig. 1A). The inclusions were positive for the HSV type I specific immunostain (Fig. 1B), but were negative for the CMV specific immunostain.
PMC5966627_02
Change of Serum levels of ALT and AST enzymes after the initiation of empirical acyclovir treatment in case 2. Serum samples were withdrawn at the indicated time points from the patient described in case 2 following the initiation of acyclovir treatment (Time of initiation = Zero). ALT and AST levels are expressed in International Units (I.U) while time is expressed in hours.
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The follow up examination of liver enzyme levels showed a significant improvement until they became within the normal reference range 60 hours after the initiation of acyclovir treatment (Fig. 2).