Pathological study on fulminant change of chronic liver disease

Abstract

Autopsy cases of acute hepatic failure (clinically resembling fulminant hepatitis) occurring in the course of chronic liver disease were studied clinico-pathologically. Among total 29 cases, 10 cases were hepatitis B virus carrier, 6 were alcoholics, 4 were lupoid hepatitis or related disease, 3 had past history of thorotrast exposure and 2 were Banti's syndrome. The possible trigger of fulminant change were operation, transfusion, massive intake of alcohol, drug and severe systemic infection including endotoxemia. Postmortem examination revealed significant part of these cases showed “map-like” hepatic necrosis, marked centrilobular necrosis, and multiple fibrin thrombi in the liver and the other organs. Considering clinical backgrounds of long term steroid administration for preceding disease other than hepatitis and endotoxemia together with these pathological findings, it could be conceivable to interpret at least some part of these cases as a human counterpart of “univesceral Shwartzman reaction” of the liver (Mori). © 1987, The Japan Society of Hepatology. All rights reserved.