Histologic changes in the liver biopsy in Amanita phalloides intoxication

Abstract

Eight cases of nonfatal Amanita phalloides intoxication are described. They presented with elevation of transaminase activity but usually not of the serum bilirubin. Histologically they showed centrilobular necrosis with collapse, initally without significant inflammation. Steatosis was absent. Subsequently, macrophages appeared around the areas of necrosis. These often contained bulky, sometimes iron-positive ceroid pigment. The Kupffer cells became activated but little portal reaction was seen. Eventually regeneration of liver cells restored the architecture. The histologic findings are fairly uniform and typical but not specific. They contrast distinctly with the well known picture in fatal intoxication dominated by steatosis.