Herpes Simplex Virus Hepatitis

HSV hepatitis is an uncommon infection that occurs in the third trimester of pregnancy or in immunosuppressed patients. Histologic features include zones of coagulative necrosis with viral cytopathic effects in adjacent viable hepatocytes, such as intranuclear inclusions (eosinophilic Cowdry type A or basophilic Cowdry type B) surrounded by clear halos with peripheral chromatin margination (ground-glass nuclei). Viral particles can be identified within hepatocytes and specific immunostains are available to exclude other viruses (e.g. CMV), which are especially helpful in the setting of immune compromise.