Liver and intrahepatic bile ducts - nontumor
General concepts
Fulminant hepatitis / massive hepatic necrosis

Topic Completed: 1 April 2012

Revised: 23 January 2019, last major update April 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Fulminant hepatitis massive hepatic necrosis

Komal Arora, M.D.
Page views in 2019: 1,925
Page views in 2020 to date: 252
Cite this page: Arora K. Fulminant hepatitis / massive hepatic necrosis. website. Accessed February 27th, 2020.
Definition / general
  • Uncommon (< 1%) complication of acute viral hepatitis
  • Progresses from onset of symptoms to hepatic encephalopathy in 2 - 3 weeks in previously healthy patient
  • Orderly regeneration due to massive destruction of confluent lobules
  • Liver can regenerate after massive necrosis if connective tissue framework is intact
  • Regeneration: portal ductules increase in size and number and become dilated
  • Individual hepatocytes with clear cytoplasm appear from ductules
  • Ductules are transformed into hepatocytes and form round cell clusters, which organize into trabeculae with fibrosis
  • Lobular architecture is established
  • May become normal at 14 months (Mod Pathol 2000;13:152)
  • Causes: viruses (hepatitis B, C), drugs (acetaminophen, carbon tetrachloride, halothane, isoniazid, rifampin), acute fatty liver of pregnancy, hepatic vein obstruction, hyperthermia, ischemia, tumor, Wilson disease
  • Subfulminant hepatitis: less rapid, up to 3 months to hepatic encephalopathy
  • Liver transplant, auxiliary partial orthotopic liver transplant
  • Mortality without liver transplant is 25 - 90% (Semin Liver Dis 2008;28:175)
Case reports - causes
Gross images

Images hosted on other servers:

Post DPH and TMP-SMZ: necrosis at autopsy

Microscopic (histologic) description
  • Massive necrosis of hepatocytes in all zones (possible periportal sparing) with reticulin collapse, often with minimal inflammatory reaction
  • May be bile duct proliferation, lymphocytic infiltration of central veins
  • Biopsies may have minimal findings due to variability of disease
Microscopic (histologic) images

Images hosted on other servers:

Hepatocyte necrosis,
chronic inflammatory
infiltrate and bile
duct proliferation

Post acetic acid periportal fibrosis

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