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1. Introduction
Syncytial giant cell hepatitis (GCH) is a condition characterized by inflammation and multinucleated hepatocytes, commonly found in wide spectrum of neonatal and infantile liver diseases [1]. On the contrary, this entity is considerably rare in adult patients with or without underlying liver diseases and, therefore, the term postinfantile GCH (PIGCH) is used for these cases. PIGCH is a nonspecific subtype of hepatitis which can be seen in a wide variety of inflammatory and cholestatic liver diseases, representing an enigmatic regenerative response of the hepatocytes to various noxious stimuli [2]. Neither pathogenesis nor the aetiology of PIGCH is known with certainty [2–5]. To date, only approximately 100 cases in adults have been described in the English literature during the past three decades [2]. PIGCH has been linked with drugs toxicity, viruses, and autoimmune liver diseases, with autoimmune hepatitis (AIH) being the most prevalent of all causes, accounting for approximately 40% of the published cases [2, 4–8]. The clinical outcome of patients depends on the underlying aetiology and varies from normalization of liver histology to progression to cirrhosis or even fulminant hepatitis [2, 6, 7].
Herein, we present a fatal case of histologically proven PIGCH with features of acute severe AIH (AS-AIH) probably triggered by diclofenac administration in a patient with myelofibrosis and no past history of liver disease.
2. Case Presentation
A 76-year-old woman was admitted to our department because of 10-day history of right upper quadrant abdominal pain that extended to the back and progressive deep jaundice. The patient had sought medical help 7 days before admission because of the same pain which was considered as of musculoskeletal origin and, therefore, nonsteroid anti-inflammatory drugs (NSAIDs) were prescribed by her doctor. The patient received diclofenac 50 mg PO twice per day, which was stopped at admission. Blood biochemistry at that time point was normal. However, there was no relief of the symptoms, while she mentioned the onset of nausea and vomiting accompanied by jaundice after 3 days of diclofenac administration but she continued taking the drug. The patient had a past medical history of primary...