Liver, drug injury [LMP38464]

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Diagnostic Modality: 
Whole Slide Image
Disease Category: 
Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death
Diagnosis: 
Acetaminophen Toxicity
Species: 
Human
Organ System: 
Liver and Biliary Tract
Gender: 
Female
Age: 
1 Year
Diagnosis Code: 
ICD-10: K71.1
Slide Contributor Information
Catherine
Chung

Keywords

Drug toxicity, centrilobular necrosis, zonal coagulative necrosis, submassive hepatic necrosis, acute liver failure

Clinical History

1-year-old female with acute liver failure in the setting of a one week history of fever and dry cough. No stigmata of chronic liver disease. Due to initial lab results, hemophagocytic lymphohistiocytosis was favoured clinically.

Clinical Discussion

The findings are characteristic of drug/toxin-induced liver injury. The patient’s fever had been treated symptomatically with acetaminophen (dosage unknown) and the mother revealed finding the child with an open bottle of acetaminophen (amount ingested, if any, unknown).

The liver biopsy shows distinct centrilobular necrosis (zonal coagulative necrosis). The necrotic epatocytes have characteristic hypereosinophilic granular cytoplasm with loss of or pyknotic nuclei. Viable hepatocytes in zone 1 and 2 show swelling and steatosis. The latter has been described as a frequent finding in the zonal pattern of coagulative necrosis. There is minimal to absent inflammation in the portal tracts.