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Pathological Case of the Month

Lewis Barness, MD; Enid Gilbert-Barness, MD
Am J Dis Child. 1992;146(1):111-112. doi:10.1001/archpedi.1992.02160130113031.
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A 16-year-old girl was admitted to the hospital with jaundice of 2 weeks' duration. She appeared well until age 14 years, when she developed a tremor, the cause of which was not determined. Menarche occurred at age 15 years.

On admission, she was markedly jaundiced and extremely lethargic. She was intermittently incoherent and had a persistent tremor. The liver edge was palpable 4 cm below the right costal margin, and the liver span was 12 cm. Ascites was present.

Laboratory values were as follows: hemoglobin, 60 g/L; serum albumin, 10 g/L; serum ammonia, 235 μmol/L; serum alanine aminotransferase, 800 U/L; aspartate aminotransferase, 600 U/L; γ-glutamyl transferase, 800 U/L; and prothrombin time, 34 seconds. Results of tests to detect hepatitis A, B, and C were negative.

A diagnosis of fulminant hepatitis with cirrhosis was made. After additional tests, a liver transplant was performed. The gross appearance of


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