Fatal herpes simplex virus hepatitis complicating chemotherapy with weekly docetaxel

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Abstract
We report a 50-year-old female patient who was diagnosed with metastatic breast cancer 3.5 years ago. Her most recent treatment for liver and lymph node metastases was docetaxel given on a weekly schedule. Standard prophylaxis with dexamethasone prior to each docetaxel infusion was given. After a 6-week course, a computed tomography (CT) scan revealed partial remission of the liver and lymph node metastases. Therapy was resumed after a 3-week interval. The patient was hospitalized with a decreased performance status (suffering from nausea and vomiting) 72 h after administration of dexamethasone and docetaxel. Laboratory analysis showed an anicteric hepatitis with pronounced elevation of serum aminotransferases (aspartate aminotransferase 3283 U/l, alanine aminotransferase 1987 U/l), but normal bilirubin and leukopenia (0.6 × 109/l). No mucocutaneous lesions, typically suggestive of herpes simplex virus (HSV) infection, were detectable. Despite intensive supportive care the patient died of fulminant liver failure on the fifth day after chemotherapy. A liver biopsy taken immediately post mortem disclosed the striking pathological finding of non-inflammatory liver necrosis with classical features of internuclear eosinophilic inclusion bodies, and a homogeneous immunohistochemical staining for HSV.