Fatal HSV-2 primary infection most likely acquired by kidney transplantation: a case report.

Herpes simplex virus 2 (HSV-2) rarely causes severe disease, even in solid organ transplant recipients. We describe here a fatal case of HSV-2 infection probably transmitted from a donor to a kidney transplant recipient. The donor was seropositive for HSV-2 but not for HSV-1, whereas the recipient was seronegative for both viruses before transplantation, suggesting that the graft was the source of infection. The recipient received valganciclovir prophylaxis due to cytomegalovirus seropositivity. Three months after transplantation, the recipient presented with rapidly disseminated cutaneous HSV-2 infection with meningoencephalitis. The HSV-2 strain was resistant to acyclovir, probably acquired under valganciclovir prophylaxis. Despite the early initiation of acyclovir therapy, the patient died. This fatal case of HSV-2 infection probably transmitted by the kidney graft with acyclovir-resistant HSV-2 from the onset is uncommon.