PMC5283959_01
The clinical course of the liver dysfunction and eosinophilia in the present case.
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The clinical course of the present patient is shown in Figure 1, 2.
The clinical course of the coagulation disorder in the present case.
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The clinical course of the present patient is shown in Figure 1, 2.
Skin rashes covering the whole body of the patient.
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A rash covering the whole body was observed, including the face, trunk, and extremities, up to approximately 50% of the body surface without skin peeling or mucous membrane ulceration (Fig. 3).
Abdominal ultrasonography and contrast-enhanced computed tomography (CE-CT) images of the patient. (a) The ultrasonography findings of the patient before the daclatasvir and asunaprevir combination therapy. (b) The ultrasonography findings of the patient on admission. (c) The ultrasonography findings of the patient 4 weeks after discontinuing the daclatasvir and asunaprevir combination therapy. (d) (e) The axial CE-CT images of the patient. (d) The periportal collar sign (arrow) and (e) subserosal edema of the gallbladder wall (arrowhead) were revealed. (f) Sagittal contrast-enhanced computed tomography revealed the periportal collar sign (arrow) and subserosal edema of the gallbladder wall (arrowhead).
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Abdominal ultrasonography and contrast-enhanced computed tomography (CT) revealed hepatomegaly, dullness of the edge and periportal collar signs in the liver, and marked wall thickness and sludge accumulation of the gallbladder (Fig. 4).
The histopathological findings of the liver biopsy specimen. (a) Hematoxylin and Eosin (H&E) staining, of the liver biopsy specimen before starting the combination therapy. Liver section showed moderate chronic inflammatory infiltrates in the expanded portal areas with mild fibrosis (Scale bar=200 mum). (b) (c) (d) H&E staining of the liver biopsy specimen on admission showed moderate acute eosinophil infiltration in the liver parenchyma and expanded portal areas with the features of interface hepatitis and mild fibrosis (Scale bars=200 mum and 50 mum, respectively). (e) Silver impregnation staining of the liver biopsy specimen on admission showed no increase in the reticular or collagen fibers (Scale bar=50 mum). (f) Periodic acid schiff with diastase digestion (D-PAS) staining of the liver biopsy specimen on admission showed an increased number of Kupffer cells (arrows) in the sinusoid (Scale bar=50 mum).
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Hematoxylin and eosin staining of liver biopsy before the initiation of the combination therapy showed moderate chronic inflammatory infiltrates in the expanded portal areas with mild fibrosis (Fig. 5a). Lymphocytes in the hepatic lobes and portal areas with interface hepatitis and mild fibrosis were demonstrated (Fig. 5b-d). No increases were noted in the levels of reticular fiber and collagen fiber on silver impregnation staining (Fig. 5e). Periodic acid schiff with diastase digestion (D-PAS) staining showed increased numbers of Kupffer cells in the sinusoid, indicating acute liver injury (Fig. 5f).