Liver impairment occurs in up to 60% of patients who suffer from severe acute respiratory syndrome (SARS).
In this study, physicians from Hong Kong, China, report the clinical course and liver pathology in 3 SARS patients with liver impairment.
The patients all fulfilled the World Health Organization case definition of probable SARS. They also developed marked elevation of alanine aminotransferase.
The physicians performed percutaneous liver biopsies, and specimens were examined using light and electron microscopy, as well as immunohistochemistry.
|RT-PCR found evidence of SARS-associated coronavirus in the liver tissues.|
In addition, the team used RT-PCR to find evidence of SARS-associated coronavirus infection.
The physicians found a marked accumulation of cells in mitosis in 2 patients, and apoptosis in all 3.
The team also identified ballooning of hepatocytes and mild to moderate lobular lymphocytic infiltration.
There was no eosinophilic infiltration, granuloma, cholestasis, fibrosis, or fibrin deposition.
The immunohistochemical studies showed that 0.5% to 11% of nuclei were positive for proliferative antigen Ki-67.
In addition, RT-PCR found evidence of SARS-associated coronavirus in the liver tissues, but not in the sera, of all 3 patients.
Dr Tai-Nin Chau's team concluded, "Hepatic impairment in patients with SARS is due to SARS-associated coronavirus infection of the liver".
"The prominence of mitotic activity of hepatocytes is unique and may be due to a hyperproliferative state with or without disruption of cell cycle by the coronavirus".
"With better knowledge of pathogenesis, specific therapy may be targeted to reduce viral replication and modify the disease course".