LIVER-BIOPSY FEATURES OF ACUTE HEPATITIS-C COMPARED WITH HEPATITIS-A,HEPATITIS-B, AND NON-A, NON-B, NON-C

The diagnosis of acute hepatitis C (AHC) often can only be suspected b ecause current serologic tests remain negative for over 3 months. Beca use histologic features might provide useful clues, we reviewed 85 liv er biopsy specimens from 85 patients with acute viral hepatitis, compa ring 22 cases of AHC with 23 cases of acute hepatitis A (AHA), 30 case s of acute hepatitis B (AHB), and 10 cases of acute hepatitis non-A, n on-B, non-C (AHNC). AHC was characterized by dense portal lymphoid agg regates (7 cases) and Poulsen-Christoffersen-type cholangitis (8 cases ); these lesions were not found in any other type of acute viral hepat itis, and thus appeared to be diagnostic. Sinusoidal inflammatory infi ltrates also were common in AHC, particularly in biopsy specimens obta ined during the early phase of the disease. These inflammatory infiltr ates did not appear to affect adjacent hepatocytes. Necrosis in AHC us ually was spotty and accompanied by mixed inflammatory cells. In AHNC, necrosis was also spotty but, as an added feature, pigmented macropha ges predominated in them. In AHA, necrosis was predominantly periporta l, whereas in AHB, severe zone-3 necrosis predominated. Fatty changes were predominantly microvesicular; they were common in AHC but were al so found in other groups. Collectively, the described histologic featu res allowed diagnosis of AHC in biopsy specimens with reasonable confi dence. However. histologic findings failed to predict the prognosis in individual cases.