Tissue diagnosis of HSV hepatitis was not available in all cases, and the diagnosis was made either clinically only or clinically and serologically by showing elevated antibody titers to the virus. This observation clearly indicates the importance of the early administration of intravenous antiviral therapy. A number of diagnostic methods are available for HSV detection. Serologic testing for the circulating IgG and IgM antibodies to HSV is also available using antibodies to both HSV1 and HSV2.33,34 Immunofluorescence and enzyme immunoassays are commonly used. Because of the high prevalence of HSV antibodies, serologic diagnosis of active HSV infection should be made only with detection of IgM antibody during the acute phase of the disease or demonstration of fourfold or more rise of IgG antibody after the acute phase.
Viral cultures are the slowest but the most sensitive methods in confirming the diagnosis.
We recommend serologic testing for the viral antibodies in addition to routine immunohistochemical applications of HSV antibodies on the tissue samples even in the absence of viral cytopathic effects morphologically. Although HSV is not a common cause of gestational hepatitis, clinicians and pathologists should be aware of this life-threatening but treatable entity. Anicteric acute hepatitis in the third trimester with right upper quadrant abdominal pain should alert the physician to the possibility of the diagnosis. Liver function test profile classically shows a normal serum bilirubin value, but AST and ALT are moderately elevated. The diagnosis can be confirmed by serologic testing for the HSV IgM and IgG antibodies.