case_images: PMC6304620_01
case_images: Transjugular liver biopsy was performed under X-ray fluoroscopy guidance. (a) A venogram showing a 5-Fr catheter inserted into the right hepatic vein. (b) A postbiopsy venogram, showing no leakage of contrast agent to the outside of the liver.
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case_images: PMC6304620_01_CRIHEP2018-5305691.001.jpg
case_images: fig1
case_images: A venogram was performed to confirm the position of the catheter in the RHV (Figure 1(a)). A postbiopsy venogram revealed no complications, including intraperitoneal hemorrhage (Figure 1(b)).
case_images: The histological findings of liver biopsy. (a) The specimens of transjugular liver biopsy. (b, c) Interface hepatitis with moderate inflammation and infiltrates of lymphocytes and plasma cells (arrows) in the portal area (b, magnification: x200. Hematoxylin and eosin staining; c, magnification: x400; hematoxylin and eosin staining). (d) Moderate fibrosis in the portal area and partial destruction of the hepatic lobules with piecemeal necrosis (magnification: x40; Masson's trichrome staining).
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case_images: PMC6304620_01_CRIHEP2018-5305691.002.jpg
case_images: fig2
case_images: Moderate fibrosis in the portal area and partial destruction of the hepatic lobules with partial piecemeal necrosis was also observed (Figures 2(a), 2(b), 2(c), and 2(d)).
case_images: The histological findings of bone marrow biopsy and aspiration. (a) The bone marrow was normocellular with increased megakaryocytes (arrow heads) (magnification: x200; hematoxylin and eosin staining). (b) Few platelets were visualized around and near the megakaryocytes (magnification: x400; Wright-Giemsa staining).
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case_images: PMC6304620_01_CRIHEP2018-5305691.003.jpg
case_images: fig3
case_images: Bone marrow aspiration revealed a normal nucleated cell count and a slight increase in megakaryocytes, suggestive of ITP (Figure 3).
case_images: Clinical course. T-Bil: total bilirubin; ALT: alanine aminotransferase; GGT: gamma-glutamyl transferase; TJLB: transjugular liver biopsy; SNMC: Stronger Neo-Minophagen C; PSL: prednisolone.
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case_images: PMC6304620_01_CRIHEP2018-5305691.004.jpg
case_images: fig4
case_images: PSL administration, the patient demonstrated a good response with restored liver enzyme levels and platelet counts (Figure 4). PSL was tapered to 5 mg/day as a maintenance dose.