Liver biopsy

Biopsy

Scattering

Light scattering

Immunology

Laser

Physics

Necrosis

Optics

Antigen

Inflammation

Proinflammatory cytokine

Medicine

Hepatitis

Pathology

New England Journal of Medicine

result on serum RT-qPCR assay for yellow fever.Liver-biopsy samples showed lobular necroinflammation, which included many foci of spotty necrosis, apoptosis, and hydropic hepatocyte degeneration in all lobular zones, without typical midzonal lesions associated with yellow fever, along with extensive hypercellularity and hypertrophy of Kupffer cells.Some of the patients had confluent necrosis.Among the patients who underwent liver biopsy, immunohistochemical analysis was positive for yellow fever antigen, which was found mainly in Kupffer-cell cytoplasm; such antigens are typically found in hepatocytes of the midzonal region in patients with acute yellow fever.All 26 patients recovered clinically with normal levels of liver enzymes.In a 2019 report, 5 researchers described rebound hepatitis associated with yellow fever in two travelers who had returned to France from Brazil.Similar to these investigators, we hypothesized that such cases of late-onset liver inflammation result from an impaired immune transition from an antiinflammatory pattern to a proinflammatory pattern owing to the presence of the virus or its antigens after the acute phase.In our study, the administration of sofosbuvir did not appear to be associated with subsequent changes in levels of liver enzymes.Thus, in this study, we characterized another possible clinical manifestation of yellow fever, a late-onset relapsing hepatitis occurring 1 to 4 months after the initial symptoms of severe acute yellow fever.Longer follow-up of the patients is needed to determine whether this condition will have serious health implications.

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