Figure legends
Figure 1.
Hematoxylin-eosin staining of a section of the liver shows hepatocyte
shedding around the central vein (arrowheads) and eosinophil
infiltration at the time of the first acute liver injury in October
2017.
Figure 2.
Abdominal ultrasound and computed tomography scans revealed mild
hepatosplenomegaly and periportal edema. The echo levels of the liver
are decreased and crude.
Figure 3.
(a) Hematoxylin-eosin staining of a section of the liver shows interface
hepatitis (surrounded by arrowheads) and piecemeal necrosis (arrow). (b)
Rosette (surrounded by arrowheads) and hepatocyte ballooning (arrow)
were also observed. (c) Abundant infiltration of plasma cells that have
a round, eccentrically placed nucleus and a perinuclear halo is noted.
(d) Emperipolesis (arrow), engulfment of lymphocytes (or other
inflammatory cells) by hepatocytes, probably reflecting immune-mediated
injury, was also observed at the time of the second liver injury in
January 2021.
Figure 4.
Evaluation of ALT and PT after the second onset of liver injury.
Treatment with mPSL was initiated on the day of hospitalization,
followed by maintenance with oral PSL 50 mg/day. Liver function was
exacerbated on day 8; therefore, 100 mg CyA was administered.
ALT, alanine aminotransferase; CyA, cyclosporine A; mPSL,
methylprednisolone; PSL, prednisolone; PT, prothrombin; UDCA,
ursodeoxycholic acid.