Acute Non-A, Non-B Hepatitis: The Pathologist’s Perspective

  • Zachary D. Goodman


The pathologist takes a somewhat different view of viral hepatitis than does the clinician. The pathologic view is colored by the circumstances in which tissue is obtained for examination. This in turn is often dictated by the clinical indications for biopsy with a relative increase in either atypical or chronic cases, or both, and it is also skewed toward the more severe cases seen at autopsy. The spectrum of such cases is illustrated by the consultations seen at the Armed Forces Institute of Pathology (AFIP). The Hepatic Department of the AFIP reviewed 119 cases, both biopsy and autopsy, during 1986 in which the likelihood of non-A, non-B (NANB) hepatitis was raised by the clinical circumstances (Table I). These were nearly all diagnoses of exclusion in which the morphologic patterns were consistent with viral hepatitis, the serologic studies excluded hepatitis A and B, and no drug likely to cause a hepatitis-like injury could be implicated. Of these cases, 23% showed an acute injury, with 15 cases (13%) of acute hepatitis and 12 cases (10%) of massive or submassive necrosis.


Primary Biliary Cirrhosis Acute Hepatitis Bile Duct Injury Fulminant Hepatitis Acute Viral Hepatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Zimmerman HJ: Hepatotoxicity. The Adverse Effects of Drugs and Other Chemicals on the Liver. Appleton & Lange, E. Norwalk, Connecticut, 1978.Google Scholar
  2. 2.
    Stricker BHC, Spoelstra P. Drug-induced hepatic injury. Elsevier, Amsterdam, 1985.Google Scholar
  3. 3.
    Greenstone MA, Dowd PM, Mikhailidis DP, Scheuer PJ: Hepatic vascular lesions associated with dacarbazine treatment. Br Med J 282:1744–1745, 1981.CrossRefGoogle Scholar
  4. 4.
    Dienes HP, Popper H, Arnold W, Lobeck H: Histologic observations in human hepatitis non-A, non-B. Hepatology 2:562–571, 1982.PubMedCrossRefGoogle Scholar
  5. 5.
    Kryger P, and Christoffersen P. Light microscopic morphology of acute hepatitis non-A, non-B. A comparison with hepatitis type A and S. Liver 2:200–206, 1982.PubMedGoogle Scholar
  6. 6.
    Schmidt M, Pirovino M, Altorfer J, et al: Acute hepatitis non-S, non-B: Are there any specific light microscopic features Liver 2:61–67, 1982.Google Scholar
  7. 7.
    Poulsen H, Christoffersen S: Abnormal bile duct epithelium in chronic aggressive hepatitis and cirrhosis. A review of morphology and clinical, biochemical, and immunologie features. Hum Pathol 3:217–225, 1972.PubMedCrossRefGoogle Scholar
  8. 8.
    Bernau J, Rueff B, Benhamou JP: Fulminant and subfulminant liver failure: Definitions and causes. Semin Liv Dis 6:97–106, 1986.CrossRefGoogle Scholar
  9. 9.
    Rakela J, Lange SM, Ludwig J, Baldus WP: Fulminant hepatitis: Mayo Clinic experience with 34 cases. Mayo Clin Proc 60:289–292, 1985.PubMedGoogle Scholar
  10. 10.
    Teixeira MR, Weiler IVD, Murray A, et al: The pathology of hepatitis A in man. Liver 2:53–60, 1982.PubMedGoogle Scholar
  11. 11.
    Abe H, Beninger PR, Ikejiri N, et al: Light microscopic findings of liver biopsy specimens from patients with hepatitis type A and comparison with type B. Gastroenterology 82:938–947, 1982.PubMedGoogle Scholar
  12. 12.
    Okuno T, Sano A, Deguchi T, et al: The pathology of acute hepatitis A in humans. Comparison with acute hepatitis B. Am J Clin Pathol 81:162–169, 1984.PubMedGoogle Scholar
  13. 13.
    Houthoff HJ, Niermeijer P, Gips CH, et al: Hepatic morphologic findings and viral antigens in acute hepatitis B. A longitudinal study. Virchows Arch A Pathol Anat Histol 389:153–166, 1980.PubMedCrossRefGoogle Scholar
  14. 14.
    Omata M, Iwama S, Sumida M, et al: Clinico-pathological study of acute non-S, non-B post-transfusion hepatitis: Histological features of liver biopsies in acute phase. Liver 1:201–208, 1981.PubMedGoogle Scholar
  15. 15.
    Popper H, Thung SN, Gerber MA, et al: Histologic studies of severe delta agent infection in Venezuelan Indians. Hepatology 3:906–912, 1983.PubMedCrossRefGoogle Scholar
  16. 16.
    Buitrago B, Popper H, Hadler SC, et al: Specific histologic features of Santa Marta hepatitis: A severe form of delta virus infection in northern South America. Hepatology 6:1285–1291, 1986.PubMedCrossRefGoogle Scholar
  17. 17.
    Govindarajan S, DeCock KM, Peters RL: Morphologic and immunohistochemical features of fulminant delta hepatitis. Hum Pathol 16:262–267, 1985.PubMedCrossRefGoogle Scholar
  18. 18.
    Lefkowitch JH, Goldstein H, Yatto R, Gerber MA: Cytopathic liver injury in acute delta virus hepatitis. Gastroenterology 92:1262–1266, 1987.PubMedGoogle Scholar
  19. 19.
    Ishak KG: The liver, in Riddell RH (ed): Pathology of Drug-Induced and Toxic Diseases. Churchill Livingstone, New York, 1982, pp. 457–513.Google Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Zachary D. Goodman
    • 1
  1. 1.Department of Hepatic PathologyArmed Forces Institute of PathologyUSA

Personalised recommendations