13267              ACUTE HEPATIC NECROSIS

The patient was a boy aged 3 years and 4 months.  He began to feel unwell 5 days before admission.  At this time the urine was noted to be dark and within 3 days the child was jaundiced and the stools were pale-coloured.  There was occasional vomiting and some abdominal pain.  There was no history of contact with infectious hepatitis.  There was a fever of 39.5oC and the liver was tender and firm.  Bilateral otitis media developed which was treated with penicillin.  The persistent high fever aroused a suspicious of ascending cholangitis.  Ten days after admission there was drowsiness and irritability, prothrombin activity was 5% of normal and the liver began to shrink rapidly.  Liver failure was diagnosed.  Pulmonary oedema then necessitated digitilization but the child died shortly thereafter.  At postmortem there was gross jaundice and occasional haemorrhages in the skin.  The liver was small and the spleen was slightly enlarged.

The specimen consists of the liver.  It is slightly small and flabby and the capsule is a little wrinkled.  The cut surface shows vague lobulation but no striking naked-eye features.  Histology shows massive necrosis of almost all the liver cells.  There is a diffuse infiltration of polymorphs, lymphocytes, macrophages and plasma cells among the collapsed reticulum.  There is some bile retention.