case_images: PMC9579323_01
case_images: Magnetic resonance cholangiopancreatography (MRCP) results of the patient. MRCP showed edema of the first porta hepatis and the periportal region (A,B) and thickness of the gallbladder wall (C) at the beginning of treatment (thick arrow), and they were resolved after treatment (D-F). However, MRCP showed a narrow bile duct that was not relieved during hospitalization (G,H).
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case_images: F1
case_images: M2, and ss-DNA) and metabolism disease-related tests (including blood glucose, blood ammonia, lactate, alpha-fetoprotein, and ceruloplasmin) were also negative. Abdominal ultrasound indicated hepatosplenomegaly, pericholecystic edema, and thickening of the gallbladder wall. Magnetic resonance cholangiopancreatography (MRCP) showed edema of the first porta hepatis, the periportal region, and the gallbladder, as well as stenosis of the choledoch (Figures 1A-C,G). MRCP tests showed that the narrow bile duct was not relieved, but the hepatosplenomegaly and gallbladder edema had disappeared (Figures 1D-F,H).
case_images: Results of liver histology of the patient. (A-C) Liver biopsy results. H&E staining of liver tissue showed swollen hepatocytes and inflammatory cells infiltrating into portal duct areas, and there was mild interfacial inflammation (A). Masson staining indicated mild hepatic fibrosis in the portal area (B). Immunohistochemical staining of CD8 + T-lymphocytes (C). (D) The result of electron microscopy showed chronic active hepatitis. No viral inclusions were found.
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case_images: F2
case_images: Trio-NGS did not detect any abnormalities, while liver biopsy showed mild interfacial hepatitis and fibrosis of portal area (G1S1) (Figures 2A,B), and further classification of the intrahepatic lymphocytes predominantly suggested CD8 + cells (Figure 2C). The result of electron microscopy (Figure 2D) indicated chronic active hepatitis, which was shown as follows: hepatic cells were swollen, rough endoplasmic reticulum and smooth endoplasmic reticulum were slightly expanded, and lipid droplets were observed in hepatocytes (upper image), as well as lymphocytosis were observed in hepatic sinusoidal (lower image).
case_images: Results of metagenomic sequencing. (A) Sequencing results of whole blood. (B) Sequencing results of liver tissue.
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case_images: Finally, torque teno virus (TTV) sequences were detected by metagenomic NGS (mNGS) in whole blood sample (Figure 3A) and liver tissue (Figure 3B).
case_images: Schematic diagram of the transaminase and bilirubin fluctuations during treatment. The alanine aminotransferase (A), aspartate aminotransferase (B), and total bilirubin (C) levels were tested every 3-5 days during treatment. Ceftazidime was used for the first two weeks followed by methylprednisolone treatment. The patient also received plasma exchange once due to rapid aggravation of jaundice.
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case_images: F4
case_images: TB: 173 mumol/L), underwent plasmapheresis once, and was administered methylprednisolone. The patient's liver function was improved after the administration of steroids (Figures 4A-C).