PMC4706270_01
Liver biopsy results at the first admission showed massive infiltration of neutrophils.
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F1
The patient underwent a liver biopsy, which revealed massive infiltration of neutrophils, strongly suggesting acute hepatitis (Figure 1).
A, Clinical course of the first admission. B, Clinical course of the second admission. C, Clinical course of the third admission. ALT = alanine aminotransferase, AST = aspartate aminotransferase, PSL = prednisolone, PT = prothrombin time, TBIL = total bilirubin.
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F2
The clinical course of the first admission is shown in Figure 2A. Four months after discharge, the patient's liver function showed worsening at a regular outpatient examination (AST level, 254 IU/L; ALT level, 420 IU/L; total bilirubin level, 1.8 mg/dL; and PT-INR, 1.19), and he was again admitted to our hospital (Figure 2B). Four months after his second discharge, the patient was again admitted to our hospital for acute liver failure, with an AST level of 617 IU/L, ALT level of 1145 IU/L, total bilirubin level of 7.7 mg/dL, PT-INR of 1.27, and grade I hepatic encephalopathy (Figure 2C).
Liver biopsy results at the third admission revealed more severe infiltration of neutrophils compared with his previous biopsy.
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F3
Another liver biopsy was performed, which revealed more severe infiltration of neutrophils compared with his previous biopsy (Figure 3), a finding compatible with toxic hepatitis.