PMC8593462_01
(A) Timeline of liver function tests (LFTs) that expands the duration of initiation to cessation of Kaftrio with the boxes represent significant events. (B) Medium power of peri-central necrosis. (C) High power of peri-central necrosis, showing hepatocytes that have died and a mixture of pigment-laden macrophages, sparse inflammatory cells, and an occasional apoptotic body. CV - central vein, arrow - apoptotic body. (D) Portal tract showing intact margin, expected primary contents (hepatic artery branch, portal vein branch and bile duct radicle), with minimal chronic inflammatory cells and peripheral ductular metaplasia.
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Seven months later, we detected early signs of deranged liver function tests (LFTs) (Fig. 1A) and repeated the measurements at six, seven, eight and nine weeks. As the transaminitis continued to worsen, we carried out a percutaneous liver biopsy which revealed extensive confluent necrosis with loss of cells in zone 3 areas, focally verging on bridging necrosis (Fig. 1B). Some portal tracts had peripheral ductular metaplasia, although there was no permanent fibrosis, and the contents were present and appeared normal (Fig. 1D).