Author Affiliation: Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Grand Rounds at the Clinical Center of the National
Institutes of Health Section Editors: John I. Gallin, MD, the Clinical
Center of the National Institutes of Health, Bethesda, Md; David S. Cooper,
MD, Contributing Editor, JAMA.
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 T cells.
Young NS. Acquired Aplastic Anemia. JAMA. 1999;282(3):271-278. doi:10.1001/jama.282.3.271