Herpes simplex dissemination following glucocorticoids for upper airway obstruction in an adolescent girl

Abstract

A previously healthy adolescent female suddenly developed a severe febrile pharyngitis and impending upper airway obstruction. Her Monospot test was positive, and her throat culture grew group A beta-hemolytic streptococcus. After treatment with antibiotics and glucocorticoids, she developed a fulminant course dominated by disseminated intravascular coagulation and hepatic necrosis. At autopsy, herpes simplex virus type-1 was cultured from lung, liver, and spleen tissue. We believe this is the first report of disseminated herpes simplex infection after steroid use for upper airway obstruction.