1972 Volume 13 Issue 5 Pages 899-903
A 14 old male who became icteric after fever and diarrhea was diagnosed as having acute hepatitis in April, 1970. Although steroid hormone was instituted jaundice continued. Four months later serum γ-globulin was found to be low as 3%, and the patient was referred to our clinic for a thorough examination. Physical examination on admission revealed an icteric young male, and the liver was palpable three finger breadth beneath the right costal margin. Hematological examination showed: RBC 400×104, Hb 13.2 g/dl, WBC 6,000 and plasma clot time 89.2sec., all being within normal limits. Liver function tests at onset of jaundice were as follows: GOT 860 KU, GPT 890 KU, ZST 5.3 KU, bilirubin 20.5 mg/dl, alkaline phosphatase 26.0 KAU and total cholesterol 152 mg/dl, and those on admission to our clinic showed: GOT 173 KU, GPT 180 KU, ZST 0.6 KU, bilirubin 29.2 mg/dl, alkaline phosphatase 9.8 KAU and total cholesterol 245 mg/dl. ZST level was always low in our clinic, and so was γ-globulin. It was assumed that hypogammaglobulinemia was following acute hepatitis.
In October 1970, as liver functions became better, bleeding tendency occurred, and a marked decrease of the peripheral blood cells (RBC 152×104, WBC 1,100 and pletelet 16,000) developed. Bone marrow aspirate showed hypoplasia in all three elements and no plasma cell. Treatment was started with steroid hormone, protein anabolic hormone and fresh blood transfusion (total 8,230 ml.), and patient felt well by the end of Feb. 1971. In early May the Australian Antigen test became positive, and patient died of acute serum hepatitis in the middle of June. At autopsy the bone marrow was aplastic, and the liver weighed 1,120 gm. Chloramphenicol was not used all through the course.
