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liver transplantation, hepatitis, liver biopsy
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 carcinoma
and 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, direct
bilirubin 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 possible
differential 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)