Acute hepatic necrosis in a case of
acute cholecystitis
Jason A. Bolton, Bijendra Patel and Hannah Simms
Corresponding address:
Mr Bijendra Patel,
Academic Department of upper GI Surgery,
The Royal London Hospital,
London, E1 1BB, UK.
E-mail: bijendra.patel@bartsandthelondon.nhs.uk
A 73-year-old Asian gentleman was admitted via the Accident and Emergency Department
with upper abdominal pain, jaundice, fever and rigors. Past history included non-insulin
dependant diabetes, asthma, psoriasis and alcoholism. His drug history included methotrexate.
A diagnosis of acute cholecystitis was made and ultrasound findings were consistent with this.
The patient started to improve but on day 8 of his admission he suddenly deteriorated and
arrested. The post mortem revealed complete hepatic necrosis as an unexpected cause of death.
There are a number of factors which may be contributory in this case. The fact that our patient
expired so rapidly with complete hepatic necrosis was not in keeping with the typical chronic
course one might expect. We should always bear in mind the potential for fatal hepatic injury
in patients presenting with hepatobiliary symptoms with a past history of alcohol abuse and
methotrexate therapy.
Keywords
General surgery; drugs; pathology; cholecystitis; alcoholism; methotrexate; hepatic necrosis.
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