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.