A Novel Histological Lesion in Glucocorticoid-Responsive Chronic Hepatitis

DANIEL S. PRATT,* KARIM A. FAWAZ,* ARTHUR RABSON,‡ RONALD DELLELIS,‡ and MARSHALL M. KAPLAN*

Divisions of *Gastroenterology and ‡Pathology, New England Medical Center, and Tufts University School of Medicine, Boston, Massachusetts

In patients with chronic hepatitis, the diagnosis of autoimmune hepatitis is made on the basis of increased <Picture: gamma>-globulin levels and the presence of circulating autoantibodies. Because these test results are not abnormal universally in patients with autoimmune hepatitis, liver biopsy remains an important part of the evaluation. The classical histological finding in autoimmune hepatitis is lymphocytic infiltration of the portal triads and periportal zone (zone 1) with periportal hepatocyte necrosis. This case report describes 4 patients with glucocorticoid-responsive hepatitis, presumably autoimmune in nature, who had pericentral necrosis (zone 3) with relative sparing of the portal areas in their liver biopsy specimens, a previously undescribed histological finding in autoimmune hepatitis.

Address requests for reprints to: Daniel S. Pratt, M.D., New England Medical Center, Box 233, 750 Washington Street, Boston, Massachusetts 02111.

© 1997 by the American Gastroenterological Association