Acetaminophen-induced liver injury with atypical histopathologic findings: a case report

Abstract

A woman in her 90's was admitted for the treatment of lumbar oppression fracture. At the time of admission, her liver function was normal, and she was negative for hepatitis B surface antigen, hepatitis C virus antibody, antinuclear antibody, and anti-mitochondrial antibody-M2. On day 26 of acetaminophen administration for pain relief, the patient showed increased liver enzyme levels (AST 251 U/l, ALT 197 U/l, ALP 327 U/l, γ-GTP 256 U/l, T-Bil 0.4 mg/dl), a blood eosinophil count of 16.1%, and tested negative for IgM-hepatitis B core, IgA-hepatitis E, IgM-hepatitis A, IgM-Epstein-Barr virus, or IgM-cytomegalovirus antibodies, indicating hepatic disorder. Acetaminophen-induced injury was suspected, and liver biopsy was conducted. Histological examination of the liver revealed atypical findings, including moderate lymphocytic infiltration, mild eosinophil infiltration, and neutrophil infiltration with cholangitis in the portal area; however, no central zone necrosis was observed. Hepatobiliary enzyme levels normalized immediately after acetaminophen was discontinued.