PMC5337457_01
The histological findings of a bone marrow examination. (a) Normoplastic marrow with platelet depletion was evident. (b) Megakaryocytes without dysplasia were present. Magnification: (a) x40, Hematoxylin and Eosin (H&E) staining; (b) x400, H&E staining.
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A bone marrow examination uncovered normoplastic marrow with platelet depletion and a megakaryocyte count of 30/muL (Fig. 1).
Clinical course.
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The patient promptly began treatment with 30 mg/day (0.6 mg/kg/day) of PSL on Day 5 of admission, which quickly restored her liver enzyme levels to within normal limits (Fig. 2). Restoring the steroid dose to 20 mg/day normalized her laboratory findings, and the serum transaminase and IgG levels and platelet count have since remained normal for over 19 months with a maintenance dose of 10 mg/day PSL (Fig. 2).
The histological findings of liver biopsy. (a) The pathological diagnosis was mild chronic hepatitis. (b) Mild portal and perivenular fibrosis was seen. (c) The specimen exhibited centrilobular necrosis. (d) The specimen showed infiltration of inflammatory cells consisting of lymphocytes and plasma cells, with mild interface hepatitis in the portal zone. Magnification: (a) x40, Hematoxylin and Eosin (H&E) staining; (b) x40, Azan-Mallory staining; (c) and (d) x400, H&E staining.
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A percutaneous liver biopsy specimen was obtained on Day 14 (Fig. 3) since the platelet numbers had increased to approximately 10x104/muL. Tissue histology revealed centrilobular necrosis (Fig. 3a and c), infiltration of lymphocytic and plasma cells, and mild interface hepatitis around the portal vein (Fig. 3a and d). The inflammatory activity and fibrosis stage were classified as A1F1 (Fig. 3a and b) according to the Metavia scoring system.