When the pathologist is not too late (for once) – rare infectious causes of acute hepatic dysfunction with distinct histopathological features.

Background Hepatic dysfunction of unknown cause is a major challenge for both treating physicians as well as pathologists involved in the diagnostic workup. The acute presentation of these patients and the broad spectrum of differential diagnoses remain a challenge. Core liver biopsy is a key diagnostic tool in evaluating acute hepatic dysfunction of unknown cause and may help to differentiate between infectious and non-infectious causes.

Material and Methods Retrospective cases of core liver biopsies in patients with hepatic dysfunction of unknown cause and laboratory confirmed infection at University Hospital rechts der Isar; Munich, were evaluated regarding histopathological criteria of infection. Both common and rare infectious causes of acute hepatic dysfunction were identified in this patient cohort. Overall, six cases with confirmed infection with Hepatitis A, Herpes simplex Virus, Adenovirus, and Coxiella burnettii were included.

Results Certain infections leading to hepatic dysfunction result in distinct histopathological changes that can be identified by the trained pathologist. Knowledge of these changes can aid in identifying infections as causes of hepatic dysfunction, in particular when blood tests for rare infectious causes have not yet been ordered by the treating physicians. Therefore, the pathologist may be able to initiate further confirmatory laboratory testing and definitive therapy in these medical emergencies.

Publication History

Article published online:
18 January 2023