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. 2023 Mar 30;617(7961):564–573. doi: 10.1038/s41586-023-06003-w

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Extended Data Fig. 5 — a & b, H&E sections x100 and x200 showing a pattern of acute hepatitis with parenchymal disarray, there is a normal, uninflamed, portal tract lower left image a. Spotty inflammation and apoptotic bodies are shown in b along with perivenular hepatocyte loss/necrosis. Immunohistochemistry shows fewer mature B lymphocytes (CD20 panel c) than T lymphocytes (CD3, panel d, pan T cell marker) most of which are cytotoxic CD8 lymphocytes (panel e). In conclusion the livers of these children have a distinctive pattern of damage which does not indicate a specific aetiology, it does not exclude but does not offer positive support for either autoimmune hepatitis or a direct cytopathic effect of virus on hepatocytes. Each image shows a representative result from histology carried out on a minimum of five cases.