A. El-Sharkawi 1 , S. Kripalani 1 ; 1 Emory University, Atlanta, GA (Tracking ID #75179) LEARNING OBJECTIVES: Hepatitis due to herpes simplex virus (HSV) is an uncommon, but potentially fatal cause of hepatitis that is often not considered in the differential diagnosis of acute hepatitis during pregnancy. Serological tests have limited value in establishing an early diagnosis and a high index of suspicion and early diagnostic tools, such as HSV DNA detection are essential. Early treatment with acyclovir decreases mortaility from herpes simplex hepatitis. CASE INFORMATION: A 19 y/o woman, G2 P1, with no significant PMHx, presented with premature labor at 32 weeks gestation. The initial symptoms were controlled, but over the next several days, the pt developed a cough, dyspnea, RUQ abd pain, and fever of 39C. Evaluation of blood, urine, and amniotic fluid cultures was unremarkable. CXR revealed bibasilar atelectasis versus infiltrate, and she received azithromycin and ceftriaxone for presumptive pneumonia. The pt remained febrile with increasing RUQ pain. Labs revealed declining Hb (7.1), WBC (5.6 with 56% bands), and Plt counts (62,000), with rising liver transaminases (AST 2490, ALT 796), INR 2.5, T. Bili 2.2. RUQ U/S showed hepatomegaly and fatty liver. Considering her worsening condition, obstetrics performed a C-section on hospital day 5.