Fulminant hepatitis associated with centrilobular hepatic necrosis in young children

Estella M. Alonso, Ronald J. Sokol, John Hart, R. Wesley Tyson, Michael R. Narkewicz, Peter F. Whitington

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Objective: To describe fulminant hepatic failure (FHF) in children in the United States with clinical and histopathologic features distinctly different from those typical of FHF. Patients: Seven young children were seen in early 1994 with encephalopathy, coagulopathy, and elevated aminotransferase levels. Liver failure was preceded by a prodromal viral illness that resulted in a period of fasting without dehydration. Unlike the majority of children with FHF, these patients had serum bilirubin levels <171 μmol/L (10 mg/dl). All children had received therapeutic doses of acetaminophen during the prodromal illness. Histopathologic findings: Histologic findings included zonal necrosis of hepatocytes in a centrilobular distribution, which is characteristic of toxic liver injury but is atypical for viral hepatitis and sporadic non-A non-B hepatitis. Outcome: Six patients recovered spontaneously, and one died of complications of liver failure and fungal sepsis. The cause of this disorder remains unknown, but we postulate a viral or environmental insult that preferentially damages zone 3 hepatocytes. The potential for this injury may have been augmented by ingestion of therapeutic doses of acetaminophen while patients were in a fasted state. The prognosis was good compared with typical FHF in children and correlated with the degree of liver necrosis on histologic examination. (J PEDIATR 1995;127:888-94).

Original languageEnglish (US)
Pages (from-to)888-894
Number of pages7
JournalThe Journal of pediatrics
Issue number6
StatePublished - Jan 1 1995

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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