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Pathol Res Pract. 2014 Dec;210(12):1134-7. doi: 10.1016/j.prp.2014.05.002. Epub 2014 May 16.

Weil's disease (leptospirosis) manifesting as fulminant hepatic failure: report of an autopsy case.

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Department of Pathology, Osaka Red Cross Hospital, Japan. Electronic address:
Department of Rheumatology, Osaka Red Cross Hospital, Japan.
Department of Pathology, Fujita Health University School of Medicine, Japan.


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.


Selective damage; Sinusoidal endothelial cell; Submassive hepatocellular necrosis; Weil's disease

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