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Drug-induced liver disease (view source)
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Focal hepatocyte necrosis. Drug induced liver injury (DILI) In 44 yo woman with normal bilirubin, elevated alkaline phopatase (323), slightly increased ALT (87). The patient had been taking antidepressants, which are known to have a low risk of liver injury, most commonly idiosyncratic,. A Low power shows normal triads (green arrows), in contrast to the spot of inflammation (cyan arrow).B. The spot at higher power is a granuloma not in a triad, the only such granuloma identified. C. Occasional triads show inflammation comprising mostly eosinophils. D. Occasional other foci of spotty necrosis were identified. E. Reticulin stain showed rare foci of regeneration (arrows), but no piecemeal necrosis. | Focal hepatocyte necrosis. Drug induced liver injury (DILI) In 44 yo woman with normal bilirubin, elevated alkaline phopatase (323), slightly increased ALT (87). The patient had been taking antidepressants, which are known to have a low risk of liver injury, most commonly idiosyncratic,. A Low power shows normal triads (green arrows), in contrast to the spot of inflammation (cyan arrow).B. The spot at higher power is a granuloma not in a triad, the only such granuloma identified. C. Occasional triads show inflammation comprising mostly eosinophils. D. Occasional other foci of spotty necrosis were identified. E. Reticulin stain showed rare foci of regeneration (arrows), but no piecemeal necrosis. | ||
[[File:5 32357864049788 sl 1.png|Drug induced liver injury, necroinflammatory with changes of chronic hepatitis]] | |||
[[File:5 32357864049788 sl 2.png|Drug induced liver injury, necroinflammatory with changes of chronic hepatitis]] | |||
[[File:5 32357864049788 sl 3.png|Drug induced liver injury, necroinflammatory with changes of chronic hepatitis]] | |||
[[File:5 32357864049788 sl 4.png|Drug induced liver injury, necroinflammatory with changes of chronic hepatitis]] | |||
[[File:5 32357864049788 sl 5.png|Drug induced liver injury, necroinflammatory with changes of chronic hepatitis]] | |||
[[File:5 32357864049788 sl 6.png|Drug induced liver injury, necroinflammatory with changes of chronic hepatitis]]<br> | |||
Drug induced liver injury, necroinflammatory with changes of chronic hepatitis, in a 71 year old man with history of piperacillin, after which an allergic reaction occurred, with alkaline phosphatase 221 IU/L, ALT 45 IU/L, normal AST/bilirubin, negative AMA/ANA/viral antibodies. ALT returned to normal rapidly, Alkaline phosphatase gradually resolved. ERCP did not show sclerosing cholangitis. A. Inflamed triads with interface hepatitis and mild steatosis are present at low power, along with a normal central vein. B. A focus of spotty necrosis (black arrow) lies near hepatocytes with ballooning degeneration (brown arrows); a normal portal triad (green arrow) is also seen. C. Most triads showed moderate to marked chronic inflammation with eosinophils (white arrows). Note bile ductular proliferation (black arrows) and ballooning degeneration (red arrows). D. Reticuliln showed only rare foci of piecemeal necrosis (arrow), without significant collapse or regenerative change. E. PAS-D shows a focus of chronic inflammation of the lobule with destruction of hepatocytes; note PAS-D macrophages. F. A single inflamed portal-portal bridge was seen, with macrophages, lymphocytes, and rare eosinophils, but not plasma cells or neutrophils. | |||
[[File:4 40824578186586 sl 1.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 2.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 3.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 4.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 5.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 6.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy with 9.7 mg/dl bilirubin. Most likely due to total parenteral nutrition required for his sustenance. A. Slightly edematous triad with somewhat dilated sinusoids, without inflammatory or neoplastic aggregates at low power. B. Bile filled cholangiolar spaces (green arrows) and pseudoacini (blue arrows). C. Foci of extramedullary hematopoiesis. D. Triads did not show the edema and peripheral bile ductular proliferation normally seen with obstructive cholestasis. E. CK7 shows preservation of bile duct plates. F. Reticulin shows interruption and disorganization of liver plates, consistent with isolated cell necrosis (at this age, the inflammatory foci responding to spotty necrosis on H&E are not seen). | |||
===Specific patterns=== | ===Specific patterns=== | ||