PMC8192200_01
(a) Liver biopsy (H&E, x40) showing bridging necrosis and collapse of parenchyma with cholestasis and sparse inflammatory infiltrate rich in lymphocytes and plasma cells ((b) inset x200). (c) A trichrome stain (x20) showing lack of fibrosis supporting acute nature of the illness.
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fig1
Liver biopsy showed cholestatic hepatitis with areas of resolving necrosis (Figure 1).
(a) Renal biopsy showing tubular casts comprising of hemoglobin (hemoglobin immunostained (b)) and bile pigment (Fouchet stained (c)). Glomeruli and vasculature were within normal limits.
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fig2
Renal biopsy showed acute tubular injury with bilirubin and hemoglobin casts (Figure 2).
Changes in AST, ALT, LDH, and T-Bil during hospitalization are plotted from admission at days 1-25.
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fig3
Over the next few weeks, patient's liver functions test and hemolysis labs steadily improved (Figures 3 and 4).
Changes in INR, hemoglobin, and reticulocyte counts during hospitalization are plotted from admission at days 1-25.
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fig4
Over the next few weeks, patient's liver functions test and hemolysis labs steadily improved (Figures 3 and 4).