case_images: PMC10805460_01
case_images: Time course of laboratory findings and selected clinical events. ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; UTI, urinary tract infection.
case_images: ac9-11-e01240-g001.jpg
case_images: PMC10805460_01_ac9-11-e01240-g001.jpg
case_images: F1
case_images: His total bilirubin was 7.0 mg/dL (0.0-1.5 mg/dL), conjugated bilirubin 6.1 mg/dL (0.0-0.4 mg/dL), alkaline phosphatase 354 U/L (80-350 U/L), aspartate aminotransferase 86 (10-60 U/L), GGT 15 U/L (0-50 U/L), and alanine aminotransferase 61 U/L (5-50 U/L) (Figure 1). After 2 months of treatment, his cholestasis improved (conjugated bilirubin 1.3 mg/dL) (Figure 1). The patient underwent an uncomplicated cholecystectomy at 30 months of age, after being found to have worsening cholestasis and biliary sludge on ultrasound in the setting of Enterococcus and Klebsiella pneumoniae urinary tract infection (Figure 1).
case_images: Liver biopsy pathology images showing stellate portal fibrosis (white arrow) (trichrome stain, 20x field) (A), portal inflammation with ductular proliferation (white arrow) and hepatocyte ballooning (black arrow) (H&E, 20x field) (B), hepatic lobular disarray with normal central vein (white arrow) (H&E, 20x field) (C), and canalicular cholestasis (white arrow) with rosette formation (black arrow) (H&E, 60x field) (D). H&E, hematoxylin and eosin.
case_images: ac9-11-e01240-g002.jpg
case_images: PMC10805460_01_ac9-11-e01240-g002.jpg
case_images: F2
case_images: His liver biopsy (Figure 2) showed mild hepatic portal inflammation (lymphocytes and neutrophils), stellate portal fibrosis with trichrome stain, and mild ductular proliferation with marked canalicular cholestasis.