acute hepatitisLiver inflammation of abrupt onset.
Autoimmune, drugs, idiopathic (up to 70% in some services), toxins, viral (HAV, HBV, HCV, HEV).
Low-grade fever, anorexia, nausea, vomiting, fatigue, malaise, headache, photophobia, pharyngitis, cough; later, dark urine, light stool, jaundice, hepatomegaly, ± splenomegaly, ± lymphadenopathy.
Liver biopsy; increased transaminases (ALT, AST); increased virus-specific IgG or IgM.
Acute hepatitis, differential diagnosis
Perivenular ballooning with neutrophils, Mallory bodies, steatosis, fibrosis.
No lobular disease, ± granulomas, minimal cholestasis, duct proliferation, ± ductopaenia, copper-binding protein (black dots with orcein; blue with Victoria blue).
Fibrosis vs necrosis.
Minimal portal-tract inflammation (neutrophils, eosinophils, granulomas), bile duct damage with certain agents (paraquat, floxacillin).
• EBV—minimal liver damage, atypical lymphocytes in sinusoids, portal tracts.
• CMV/HSV—confluent necrosis, scattered lymphocytes in sinusoids, viral inclusions.