Brief Communication: Severe Hepatotoxicity of Telithromycin: Three Case Reports and Literature Review

View larger version (100K): [in a new window]   Figure 1. Hepatic explant specimen from patient 2. The liver is only about one third of the normal size (480 g) and consists predominantly of diffuse collapse. Islands of surviving intact lobular parenchyma consist of regenerative nodules (arrows).

View larger version (74K): [in a new window]   Figure 2. Microscopic findings for patient 2. Left. A conventional hematoxylin–eosin stain shows only rare islands of surviving regenerative lobular cellularity (arrow). (Original magnification, x5.) Middle. Reticulin silver staining demonstrates dense condensation of fibers surrounding persisting ducts without any intervening lobules, except in the regenerative nodule (arrow). (Original magnification, x 5.) Right. Immunohistochemical stain for cytokeratin cocktail AE1/AE3 highlights the dense aggregates of ducts (arrows) uninterrupted by lobular elements. (Original magnification, x5.)

View larger version (161K): [in a new window]   Figure 3. Autopsy findings for patient 3. The figure shows total lobular necrosis, with pink hepatocytes lacking nuclei (area within arrows). Portal triads are densely infiltrated by lymphoid cells. (Hematoxylin–eosin; original magnification, x10).