Acute liver biopsy lesions in early autoimmune (“lupoid”) chronic active hepatitis

Abstract

Autoimmune (lupoid) chronic active hepatitis was studied in 2 female patients whose liver biopsies at initial presentation showed the unusual features of acute hepatitis. Centrilobular hepatocyte swelling and multinucleation, acidophilic degeneration, cholestasis, mild fatty change and bile duct damage in 1 case resembled lesions of non-A, non-B hepatitis. Lobular and portal infiltrates of plasma cells with piecemeal necrosis suggested transition to chronicity as well as an autoimmune component. This was additionally supported by the presence of hypergammaglobulinemia and auto-antibodies in both patients. Liver biopsy features in the acute presentation of lupoid hepatitis may be difficult to distinguish from those seen in acute hepatitis due to virus or drugs.