Abstract
Although herpes simplex virus, Epstein-Barr virus, and hemophagocytic lymphohistiocytosis are known causes of severe acute liver injury with or without liver failure, these diseases occur almost exclusively in immunocompromised and elderly patients. We report a case of an immunocompetent young man with no medical history who presented with a subacute cough and persistent fevers in the setting of a penile chancre. He was found to have severely elevated liver chemistries and was subsequently diagnosed with hemophagocytic lymphohistiocytosis because of disseminated herpes simplex virus type 1 and Epstein-Barr virus coinfection. He was treated with intravenous dexamethasone and acyclovir and made a complete recovery.