case_images: PMC8457963_01
case_images: (a) The liver reveals massive hepatocyte necrosis. The lobular parenchyma surrounding the central vein (CV) is devoid of hepatocytes, and the portal areas (PA) have collapsed centrally. The portal areas are involved by a dense chronic inflammatory infiltrate and bile ductular proliferation (H&E; 40x). (b) Magnified view of a portal area (PA) and limiting plate with the lobular necrosis and portion of the CV. There are numerous plasma cells with interface activity (H&E; 200x). (c) A central vein is involved by endothelialitis, depicted by chains of lymphocytes (arrows) undermining the endothelium (H&E; 200x).
case_images: CRIT2021-8484106.001.jpg
case_images: PMC8457963_01_CRIT2021-8484106.001.jpg
case_images: fig1
case_images: Hepatitis Scoring System was 7 (female +2, ALP/ALT ratio +2, IgG level +0, smooth muscle antibody +3, antimitochondrial antibody +0, viral markers -3, drugs +1, alcohol +2, immune disease +0), consistent with possible AIH. Histologic evaluation of the explanted liver was compatible with autoimmune hepatitis (Figure 1).
case_images: Selected laboratory values by postoperative day (POD). Tx: liver transplant; AST: aspartate aminotransferase; ALT: alanine aminotransferase; T-Bili: total bilirubin; IVIG: intravenous immunoglobulin.
case_images: CRIT2021-8484106.002.jpg
case_images: PMC8457963_01_CRIT2021-8484106.002.jpg
case_images: fig2
case_images: Her platelet counts recovered from 10 x 109/L (POD -2) to 106 x 109/L (POD 51) as shown in Figure 2.