To the Editor.—
Rubin et al1 reported a case of fatal fulminant hepatitis caused by herpes simplex virus (HSV) type 2 in a previously healthy young woman. It may not be coincidental that the patient had been taking oral contraceptives. We reported a similar case of disseminated HSV-2 infection in a young woman during the third trimester of pregnancy.2 Severe hepatitis was also a prominent feature of this patient's illness.Other cases of virus dissemination during pregnancy have generally been associated with primary herpesvirus infection.3 Progesterone has been reported to enhance the growth of HSV-2 in experimental animals,4 and pregnant mice are more susceptible to the lethal effects of genital herpes than nonpregnant littermates.5It is conceivable that pseudopregnancy induced by oral contraceptives produces immunosuppression sufficient to permit dissemination of virus in a host who has had no prior immunity to either HSV-1 or HSV-2.
Young EJ. Fulminant Hepatic Failure due to Genital Herpes in a Healthy Woman: Was She Healthy?. JAMA. 1985;254(24):3422. doi:10.1001/jama.1985.03360240033014