title: Weil's disease (leptospirosis) manifesting as fulminant hepatic failure: report of an autopsy case.
abstract: We report an autopsy case of a 60-year-old man with Weil's disease who died of fulminant hepatic failure. Ante-mortem blood culture yielded the growth of Leptospira interrogans (serovar icterohaemorrhagiae). At autopsy, the liver weighed 1210 g and showed a typical appearance of "acute yellow liver atrophy". Zone 3 (centrilobular region) showed submassive necrosis of hepatocytes accompanied by marked hemorrhage. Hepatocytes in zones 1 and 2 were well preserved, and the leptospira antigen was immunohistochemically demonstrated in several hepatocytes. Dissociation of liver cell plates was not observed. An immunohistochemical study demonstrated that CD31-positive, sinusoidal endothelial cells had almost completely disappeared in zone 3. This finding suggested that severe and selective damage to endothelial cells in zone 3 was the main cause of the submassive hepatocellular necrosis, which led to fulminant hepatic failure in the present case.
authors.affiliation: Department of Pathology, Osaka Red Cross Hospital, Japan. Electronic address: masa-s@sings.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shintaku
authors.affiliation: Department of Rheumatology, Osaka Red Cross Hospital, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Department of Pathology, Fujita Health University School of Medicine, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tsutsumi
mesh_terms: D001344:Autopsy; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D041383:Leptospira interrogans serovar icterohaemorrhagiae / Q000302:isolation & purification; D007922:Leptospirosis / Q000175:diagnosis / Q000473:pathology*; D008099:Liver / Q000473:pathology*; D017114:Liver Failure, Acute / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014895:Weil Disease / Q000175:diagnosis / Q000473:pathology*
keywords: Selective damage; Sinusoidal endothelial cell; Submassive hepatocellular necrosis; Weil's disease