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April 1965

Fulminant Hepatitis in a Patient With Chronic Liver DiseaseAn Unusual Case Accompanied by Polymyositis and Lichen Planus Skin Lesions

Arch Intern Med. 1965;115(4):482-489. doi:10.1001/archinte.1965.03860160108020

A CUTE viral hepatitis of both the serum and epidemic varieties is generally a self-limited disease with a favorable outcome. The mortality rate in large-scale epidemics of viral hepatitis has been found to be in the order of 0.2-0.3%.1-3 Rarely, for unknown reasons, some patients with infectious hepatitis develop massive liver cell necrosis which results clinically in a fulminant and fatal hepatitis. A clinical picture similar to that of fulminant infectious hepatitis with submassive or massive necrosis of the liver may also occur as a result of drug ingestion or toxin exposure.4

In a recent study of 12,000 autopsies, 18 cases of massive liver cell necrosis were found.5 Five of these cases were associated with blood transfusions or hepatitis exposure and four with the use of drugs or exposure to toxic agents. However, it is noteworthy that in nine cases no apparent etiology for the massive liver

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