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Confusion and lethargy in a 48 year old man
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Computed tomography of the abdomen confirms hepatosplenomegaly, a small amount of ascites and small bilateral pleural effusions (fig 1; see p 242). In view of the ascites, transjugular rather than transabdominal liver biopsy should be performed. All patients should have both a coagulation screen, platelet count, and ultrasound scan of the liver performed before liver biopsy. If the prothrombin time is 4 seconds above the control value (corresponding to international normalised ratio >1.4) then the coagulopathy should be corrected before liver biopsy. Ultrasound is essential to exclude intrahepatic duct dilatation, hydatid cyst, haemangiomata, and the presence of ascites. A transjugular liver biopsy was performed without complications.
Hepatic histology demonstrates granulomatous hepatitis. There are characteristic granulomas, both intralobular and portal tract in distribution (fig 2; see p 242). One of the granulomas is large containing fibrin-like material. Ziehl-Neelsen stains for tuberculosis and periodic acid-Schiff stains for fungi were all
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- Confusion and lethargy in a 48 year old man
- U McGivern, R N Patterson, D O’Rourke, and S D Johnston
Postgrad. Med. J. 2004 80: 242.[Extract] [Full Text] [PDF]
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