A case of post liver transplant hepatitis: the meaning of the non-specific liver biopsy result

Abstract

A 57-year-old male post liver transplant patient was admitted to the hospital due to pulmonary tuberculosis. His medical history was significant for chronic hepatitis B cirrhosis, hepatocellular carcinomaand diabetes. His current medication included sirolimus, mycophenolic acid, entecavir, insulin and antituberculosis drugs. Hepatitis was detected from his blood test with total bilirubin 0.55 mg/dL, directbilirubin 0.37 mg/dL, AST 237 U/L, ALT 70 U/L and ALP 160 U/L. Acute cellular rejection, drug/toxin induced hepatitis, tuberculosis of the liver, opportunistic infection and recurrent hepatitis B were possibledifferential diagnosis. A liver biopsy revealed only non-specific change. Without any features of acute cellular rejection, immunosuppressive drugs were reduced accordingly to bring up the immune system.The liver enzyme improved within 2 weeks thereafter. Despite a negative-biopsy result, this was still an important clinical clue which led to a proper management for post liver transplant patient.
 Figure 1 พยาธิสภาพของชิ้นเนื้อตับ ย้อมด้วย hematoxylin และ eosin (H&E) บริเวณ portal area (A) และ บริเวณ hepatic lobule (B)