Fibrosing cholestatic
hepatitis is an aggressive and usually fatal form of viral
hepatitis in immunosuppressed patients. We report three cases of fibrosing cholestatic
hepatitis in various clinical situations. Case 1 was a 50-year-old man who underwent a
liver transplant for hepatitis B virus (HBV)-associated
liver cirrhosis. Two and a half years after the transplant, he complained of
fever and
jaundice, and liver
enzymes were slightly elevated. Serum
HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppressed state after
chemotherapy for
acute lymphoblastic leukemia. He was a HBV carrier. Liver
enzymes and total
bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent
renal transplantation as a known HBV carrier. One year after the transplant,
jaundice developed abruptly, but liver
enzymes were not significantly elevated. Microscopically lobules were markedly disarrayed, showing ballooning degeneration of hepatocytes, prominent pericellular
fibrosis, and marked canalicular or intracytoplasmic
cholestasis. Portal
inflammation was mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for
HBsAg and
HBcAg in various patterns. Patients died of
liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.