Clinicopathological Conference: Fibrosing Cholestatic Hepatitis Presenting as Subacute Hepatic Failure in a Non-transplant Patient
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A 40-year-old male was admitted to the hospital in March 2007 with a history of jaundice for 2 months, abdominal distension for 1 month and altered mental status for a day. His jaundice was associated with pruritus over the past 15–20 days. There was no history of fever, abdominal pain, vomiting or gastrointestinal bleeding. The patient had taken a complementary/alternative medication (CAM) for 15 days, which was associated with worsening of jaundice. Abdominal distension had progressively increased and was associated with bilateral peripheral edema. The altered mental status was not associated with seizures or focal neurological deficits. Past medical history included nephrolithiasis 1 year ago. There was no history of blood transfusion, jaundice, diabetes mellitus, hypertension or cardiac illness. He was not a smoker and had no history of injection drug abuse, but occasionally consumed alcohol.
On physical examination, he was of moderate build, well-nourished, conscious, drowsy...
KeywordsHepatic Encephalopathy Acute Tubular Necrosis Terlipressin Hepatorenal Syndrome Acute Insult