Abstract
A 29-year-old woman was admitted to our hospital because of high fever and hemorrhagic tendency. Approximately four months prior to admission she developed perineal laceration as well as right mastitis after the delivery of the second child, and the mastitis was completely cured following Chloramphenicol administration amounting to 11 grams. She became anorectic and icteric five weeks after the onset of mastitis, and she was diagnosed as acute hepatitis by a local physician. Seven weeks after this episode she complained of high fever, chillness and hemorrhagic tendency, which continued in spite of administration of steroids and blood transfusion. Subsequently she was referred to our clinic.
Physical examination on admission revealed an icteric young woman with generalized petechiae who looked acutely ill. Hematological exams showed: RBC 1.88 million, hemoglobin 7.7 gr%, hematocrit 24% and WBC 1,200 with 95 per cent of lymphocytes. Bone marrow aspirate showed pancytopenia. She died on the 10th hospital day, that is, 10 weeks after the onset of acute hepatitis and 3 weeks after the onset of pancytopenia. Autopsy findings were: Bone marrow was fatty and strikingly hypocellular. Plasma cells and reticulum cells were predominantly present. The liver weight was 1,380 gr, showing submassive necrosis and fibrosis.
Japanese literatures were reviewed dealing two cases of fatal aplastic anemia follwing acute hepatitis, and the discussion was extended to probable pathogenetic correlations between similar type of aplstic anemia and acute hepatitis.
