The liver shows sharp areas of coagulative necrosis.
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Closer inspection of the edge of the necrosis reveals nuclear enlargement and glassy nuclei.
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The cells with the viral change did show strong immunohistochemical staining for HSV. Cowdry A inclusions are visible as eosinophilic intranuclear inclusions
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Areas away from the necrosis showed macrovesicular change and anisonucleosis. The overall inflammatory infiltrate is minimal at most.
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Both HSV 1 and 2 can involve the liver.
HSV hepatitis generally arises in immunocompromised individuals, neonates, or during pregnancy. Rarely infection does affect normal otherwise healthy individuals. Symptoms are usually nonspecific such as fever, malaise, headache, or abdominal pain. Laboratory testing reveals marked transaminase elevation.
Acyclovir and supportive care.