PMC1797842_01
PMC1797842_02
PMC1797842_03
Clinical course for each case shown by AST level. Seven episodes of acute hepatic injury occurred in five workers from the plant. Case 1's first episode occurred in May 2001, but the episode was limited only to laboratory findings. Most of the clinical episodes of acute hepatic injury occurred between July and September 2001. The second episodes of cases 1 and 2 developed after they returned to work.
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Figure 2 presents the clinical course of the cases as shown by AST concentration.
Pathologic findings of toxic hepatitis cases. (A) PAS-stained liver from case 5 showing spotty necrosis of hepatocytes and clumped Kupffer cells containing PAS-positive material (arrows); these find-ings are compatible with the remission stage of acute hepatitis and with toxic hepatitis (magnification, 400x). (B) Hematoxylin and eosin (H&E)-stained liver from case 1 showing portal tracts that are slightly enlarged and infiltrated with inflammatory cells (magnification, 400x). (C) H&E-stained liver from case 5 showing central to portal bridging necrosis (magnification, 200x). (D) Masson trichrome staining of liver from case 4 showing wide periportal necrosis extending into the portal-to-portal area, with regenerative nodules present (magnification, 100x).
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Liver biopsy was performed on all but one case (case 2) in December 2001 (Figure 3). Clumped Kupffer cells containing periodic acid-Schiff (PAS)-positive material were abundant, especially around the terminal hepatic venule (Figure 3A). Wide periportal necrosis was also identified in cases 1 and 4 (Figure 3D), and necrosis was found in the central-to-portal or portal-to-portal region, with bridging necrosis in all cases (Figure 3C).