PMC4748206_01
Liver biopsy. (A) Intraparenchymal neutrophilic infiltrate consistent with acute hepatitis. Hepatocyte destruction/necrosis is not significant (grade 1/4). Some scattered chronic inflammatory cells are also present (arrow). (B) No appreciable cirrhosis, overt cytopathic effect or fibrosis.
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F1
Liver biopsy showed significant cholestasis and mild intraparenchymal neutrophilic infiltrate in hepatocytes surrounding the central veins with no significant necrosis, bile duct injury, or steatosis (Figure 1).
Renal biopsy showing prominent brown intraluminal casts, tubular epithelial cells (black arrows), and tubular lumen (white arrows). (A) Many of the tubules are dilated and show epithelial simplification. (B) Tubule with brown staining of the epithelial lining and of the intraluminal cast.
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F2
Bile acid nephropathy was supported by renal biopsy showing prominent yellow staining of the epithelial lining and the presence of intraluminal bile casts (Figure 2).