Fulminant Hepatic Failure due to Genital Herpes in a Healthy Woman: Was She Healthy?

To the Editor.—  The report by Rubin et al¹ failed to address an important issue: underlying immunodeficiency that may have permitted the viral-induced death. This report resembles that of Auch Moedy et al,² who had alleged that a healthy infant had also died of disseminated herpes simplex infection.I criticize these reports because the authors failed to perform any immune function studies on the two patients. At the time of necropsy, serum samples can be obtained for quantitative immunoglobulins and other determinations. Death due to a ubiquitous viral agent is probably caused by inherited or acquired immune surveillance defects to specific viral agents, and it is likely that under Darwinian pressures immune-response genes have evolved in concert with ubiquitous viral agents to prevent life-threatening diseases.Our clinical studies on the Epstein-Barr virus (EBV) support the hypothesis articulated above. Supporting this notion is the report of Britton et al,