Fibrosing cholestatic hepatitis: A report of three cases

Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We report three cases of fibr osing cholestatic hepatitis in various clinical situations. Case 1 was a 50 -year-old man who underwent a liver transplant for hepatitis B virus (HBV)- associated liver cirrhosis. Two and a half years after the transplant, I-re complained of fever and jaundice, and liver enzymes were slightly elevated . Serum HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppre ssed state after chemotherapy for acute lymphoblastic leukemia. He was a HB V carrier. Liver enzymes and total bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent renal transplantation as a known HBV c arrier. One year Received: 15 April 1999 after the transplant, jaundice dev eloped abruptly, but liver enzymes were not Accepted: 26 July 1999 signific antly elevated. Microscopically lobules were markedly disarrayed, showing b allooning degeneration of hepatocytes, prominent pericellular fibrosis, and marked canalicular or intracytoplasmic cholestasis. Portal inflammation wa s mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for HBsAg and HBcAg in various patterns. Patients died of liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.