Figure 3.

Electron microscopic findings of the needle liver biopsy specimen obtained 4 days after admission. (A–B) Liver sinusoids. (A) Low-magnification view of liver sinusoids (denoted as S). The sinusoidal spaces contain lymphocytes, which adhere in clusters to DCs. Partially disrupted liver sinusoidal endothelial cells (LSECs) and coagulation necrosis of hepatocytes (white arrow) are also visible. (B) High-magnification view of the attachment of a DC to a LSEC and a lymphocyte via pseudopods (white arrowheads). S, hepatic sinusoid; DC = dendritic cell, Ly = lymphocyte, LSEC = liver sinusoidal endothelial cell. (C–E) Central vein. (C) Low-magnification view of the central vein. The central vein exhibited characteristic central zonal necrosis with confluent hepatocyte dropout and red blood cells (indicated by black stars) with an extensive inflammatory infiltrate. These findings all indicate central vein endotheliitis. The black arrow indicates the disruption of the endothelial lining cells in the central space. DC = dendritic cell, e = endothelial cell, Ly = lymphocyte, M = macrophage. (D) High-magnification view of the central vein. The capillary endothelial cells display a characteristic disrupted cytoplasmic architecture with the formation of cytoplasmic “blebs”. The white arrowhead indicates detachment of the endothelial cells. The black bracket bar indicates the attachment of a lymphocyte to an endothelial cell via a pseudopod. Ly, lymphocyte; e, endothelial cell. (E) High-magnification view showing the attachment of a DC to an endothelial cell via a pseudopod (black bracket bar). Bars denote 5, 2 or 1 μm magnification.