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Neal S. Young, MD

JAMA. 1999;282:271-278.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

CASE PRESENTATION

A 27-year-old man noted that his eyes were yellow. Questioning elicited a recent history of darkened urine, light-colored stools, and fatigue. His physician palpated a tender enlarged liver; hepatic function test results were abnormal, with levels of total bilirubin at 75 µmol/L (4.4 mg/dL), alanine aminotransferase at 2587 U/L, and aspartate aminotransferase at 856 U/L. Within 2 weeks, the levels of total bilirubin had risen to 616 µmol/L (36 mg/dL), the alanine aminotransferase to 2209 U/L, and the aspartate aminotransferase to 1190 U/L. The patient had a history of possible hepatitis virus exposure in his employment as a police officer, but serologic testing results, including polymerase chain reaction amplification, were negative for infection with hepatitis A, B, and C viruses. A liver biopsy specimen showed severe panlobular hepatitis with extensive intralobular cholestasis. Kupffer cells were prominently enlarged, and there was a sinusoidal infiltrate consisting mainly of . . . [Full Text of this Article]

DISCUSSION

Pathophysiology

Etiologies

Definitive Therapies

Late Evolution

Supportive Care

CONCLUSIONS

Author Affiliation: Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.

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