A man with history of heavy alcoholic drinking

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Piyapoom Pakvisal, M.D.
Anapat Sanpavat, M.D.
Piyawat Komolmit, M.D., Ph.D.

Keywords

alcoholic steatohepatitis, alcoholic hepatitis, alcoholic cirrhosis, liver biopsy

Abstract

A 33-year-old Thai man presented with fever and jaundice for 10 days. He had history of significant alcohol intake. Physical examination revealed tender hepatomegaly and signs of chronic liver stigmata. Laboratory results showed: TB 17.5 mg/dL; DB 13.1 mg/dL; AST 230 IU/L; ALT 77 IU/L; ALP 332 IU/L; albumin 2.5 g/dL; globulin 3.9 g/dL; PT 13.4 sec. Serum immunologic test were negative for HAV, HBV, HCV and HEV. The histological result from liver biopsy was compatible with alcoholic steatohepatitis. Maddrey’s discriminant function was 79. Prednisolone 40 mg/day was prescribed. The clinical and liver function tests gradually improved after treatment.


 


Figure 1 พยาธิสภาพของชิ้นเนื้อตับ



  • (A) ย้อม H&E (20x) พบ Macrovesicular steatosis, Ballooning hepatocyte & Mallory-Denk bodies (วงกลมสีแดง), Lobular inflammation with neutrophilic infiltrate (วงกลมสีดำ), Canalicular cholestasis (ลูกศร) 

  • (B) ย้อม H&E (40x) พบ Ballooning hepatocytes และ Mallory-Denk bodies (ลูกศร)

  • (C) ย้อม Masson’s trichrome พบ Fibrosis stage 4


Figure_1-A-300.jpg  Figure_1-B-300.jpg  Figure_1-C-300.jpg

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