Hepatitis A virus (HAV) infection is usually self-limited, but a minority of cases progress to acute liver failure (ALF), particularly, in resource-limited settings. We report a previously healthy 19-year-old woman who presented with 20 days of jaundice, dark urine, and hepatic encephalopathy. Baseline tests showed total bilirubin 18.3 mg/dL, aspartate aminotransferase 281 U/l, alanine aminotransferase 341 U/l, international normalized ratio (INR) 1.23, and positive anti-HAV immunoglobulin M/immunoglobulin G. Although she did not meet formal ALF criteria at presentation, within 72 hours, she progressed to ALF, with bilirubin rising to 28 mg/dL, INR to 1.8, and ammonia to 140 µg/dL; ultrasonography revealed hepatomegaly. In the absence of liver transplantation or continuous renal replacement therapy, a resource-adapted supportive bundle was implemented, including intravenous N-acetylcysteine, vitamin K, neuroprotection, glucose control, early enteral nutrition, conservative transfusion, and infection surveillance. Clinical and biochemical parameters improved, and she was discharged after approximately 4 weeks, with recovery on follow-up. This case highlights early warning signs and the feasibility of a structured non-transplant management pathway for HAV-associated ALF in constrained settings.

Background: Metabolic disorder-associated fatty liver disease (MASLD) is closely related to obesity and type 2 diabetes. Its pathogenesis involves many factors, including mitochondrial dysfunction, endoplasmic reticulum stress and intestinal flora disorders. Notoginsenoside R1 (NGR1) is a key bioactive component of Panax notoginseng. The purpose of this study was to investigate the therapeutic effect of notoginsenoside R1 (NGR1) on metabolic disorder-associated steatohepatitis (MASH) and its potential mechanism. Methods: Mice were fed a choline-deficient, L-amino acid-defined high-fat diet (CDAHFD) for 6 weeks and received NGR1 (50/100 mg/kg/day) in the last 3 weeks. The role of NGR1 was evaluated by developing metabolomics, proteomics and functional analysis. In addition, the effects of NGR1 on lipid droplet content, mitochondrial function and fatty acid oxidation in hepatocytes were also verified. Results: NGR1 improved MASH progression in CDAHFD-fed mice, significantly reduced liver triglyceride content from 31.2 ± 5.1 mmol/g to 20.5 ± 4.8 mg/g (p < 0.001), free fatty acid from 0.12 ± 0.03 mmol/g prot to 0.06 ± 0.028 mg/g (p < 0.001), TNF-α (p < 0.01), IL-1β (p < 0.001), α-SMA (p < 0.05) and Collagen1A1 levels (p < 0.01), as well as serum ALT and AST concentrations (p < 0.001), and alleviated hepatomegaly and lipid droplet accumulation. Metabolomics and proteomics analysis showed that NGR1 normalized liver metabolism in MASH mice and upregulated mitochondrial OXPHOS components, including NADH: ubiquinone oxidoreductase core subunit S2 (NDUFS2), and effectively reversed CDAHFD-induced mitochondrial dysfunction. Mitochondrial membrane potential and ATP production were restored. Conclusions: This study confirmed that NGR1 has significant therapeutic potential for MASH and improves mitochondrial function by upregulating NDUFS2. This study provides new insights for the future clinical treatment of MASH.

Lucio's phenomenon is a rare necrotizing skin reaction, almost exclusive to diffuse lepromatous leprosy, that can mimic systemic vasculitis and lead to diagnostic and therapeutic errors. We report the case of a 32-year-old woman from Paraguay with prolonged fever, hepatomegaly, and violaceous, painless necrotic skin lesions on her limbs. She was initially treated with corticosteroids for presumed vasculitis without clinical improvement. Physical examination revealed madarosis, lepromas, and altered thermal-pain sensitivity. Skin biopsy showed a perivascular histiocytic infiltrate with acid-fast bacilli, confirming multibacillary lepromatous leprosy. Treatment with rifampicin, dapsone, and clofazimine was initiated, resulting in good clinical evolution. Lucio's phenomenon is an immune-mediated vasculopathy that may produce false-positive serologies and mimic autoimmune diseases. Histopathological confirmation is essential to avoid unnecessary immunosuppressive therapy. It should be considered in the differential diagnosis of necrotic skin ulcers, especially in patients from endemic regions. Early recognition and specific treatment help prevent severe complications.

This study investigated the molecular characteristics and genetic diversity of Fowl adenovirus (FAdV) strains circulating in commercial broiler and layer flocks in the Southern Marmara and Aegean regions of Türkiye between January and December 2025. Liver samples (n = 120) collected from twelve flocks with increased mortality and clinical signs compatible with adenoviral infection were analyzed. Detection was performed using circular amplification technology and PCR targeting the hexon L1 region, and positive samples were sequenced for molecular characterization. BLAST analysis showed that all isolates belonged to Aviadenovirus hepatitidis and were identified as serotype 8b. Pairwise comparisons showed high nucleotide identity among isolates (97.4-100%) and 98.1-100% similarity with the Turkish reference strain MK937075. Only three isolates displayed nucleotide substitutions, while most sequences were identical within the analyzed region. Amino acid similarity ranged from 95.2% to 100%. Phylogenetic analysis revealed that all isolates clustered within a single monophyletic group together with previously reported Turkish FAdV-8b strains. Necropsy findings included hepatomegaly, multifocal hepatic pallor, petechial hemorrhages, gizzard erosion, and serous pericardial involvement. The detection of genetically closely related isolates across multiple provinces suggests regional circulation of a common viral lineage. These findings demonstrate that FAdV-8b is currently the predominant serotype associated with inclusion body hepatitis outbreaks in this major poultry production area and highlight the importance of molecular surveillance and targeted control strategies, including breeder monitoring and region-specific vaccine development.

We report the case of a 38-year-old male with sickle cell disease (SCD) who underwent elective laparoscopic cholecystectomy for recurrent biliary colic. Intraoperative exploration revealed a rare acquired cranial gallbladder malposition, with the gallbladder lying high in the subdiaphragmatic space and displaced posteriorly, in the setting of marked hepatomegaly and chronic inflammation. This abnormal positioning resulted in significant exposure limitations and difficulty achieving the classical critical view of safety. Conventional fundal traction was ineffective. Adequate exposure was ultimately achieved through direct retraction of the right hepatic lobe via the epigastric trocar, combined with surgeon repositioning and modified use of existing ports. The procedure was completed laparoscopically without conversion to open surgery or complications. This case highlights the importance of recognizing acquired gallbladder malposition as a cause of difficult cholecystectomy and underscores the need for adaptable operative strategies to achieve safe dissection.

Myeloid sarcoma (MS) is an extramedullary manifestation of acute myeloid leukemia (AML) that may occur de novo, precede, or accompany AML. Hepatic involvement is rare and poses a diagnostic challenge. We report a 65-year-old man presenting with progressive abdominal distension, massive ascites, and constitutional symptoms. Initial laboratory tests revealed bicytopenia, leukocytosis, circulating immature granulocytes, and a cholestatic pattern on liver function tests. Imaging showed homogeneous hepatomegaly with large-volume ascites. Liver biopsy demonstrated diffuse infiltration by immature myeloid cells, with immunohistochemical positivity for myeloperoxidase (MPO) and CD117. Bone marrow (BM) cytogenetic analysis revealed an isochromosome 17q, supporting the diagnosis of hepatic MS, associated with an underlying clonal myeloid neoplasm. The patient received azacitidine and venetoclax, with no response, followed by cytarabine and daunorubicin, with transient clinical improvement; however, progression to AML occurred within a few weeks. This case highlights the diagnostic challenge of hepatic MS presenting as refractory ascites, and supports consideration of early liver biopsy, with sampling from multiple sites, in patients with unexplained ascites and underlying hematologic abnormalities.

Kaposi sarcoma (KS) is an angioproliferative malignancy associated with human herpesvirus 8 and typically presents with cutaneous lesions. Visceral involvement and presentation as secondary hemophagocytic lymphohistiocytosis (HLH) are rare and may obscure the underlying diagnosis. A 45-year-old woman with hepatitis B carrier status and compensated cirrhosis presented with dizziness, fever, rash, fatigue, cytopenias, and hepatosplenomegaly. Laboratory evaluation revealed normocytic anemia, thrombocytopenia, elevated transaminases, and markedly increased inflammatory markers, prompting hospitalization for suspected infection and hematologic disease. Despite broad antimicrobial therapy and extensive investigations, her condition progressed with persistent inflammation, raising the suspicion of secondary HLH. Empirical treatment with etoposide and dexamethasone was initiated. Positron emission tomography demonstrated hypermetabolic bilateral axillary lymphadenopathy, and excisional biopsy of the right axillary lymph node revealed KS. The patient was transferred to oncology care, where therapy was changed to etoposide plus paclitaxel with clinical stabilization. KS presenting as secondary HLH is extremely uncommon and poses significant diagnostic challenges, particularly in the absence of typical cutaneous findings. This case underscores the importance of considering occult malignancy in patients with fever, cytopenias, and hepatosplenomegaly who do not respond to conventional therapy. Timely tissue diagnosis is crucial in patients with suspected HLH when the underlying cause is unclear, as the early identification of malignancy can significantly alter management and improve outcomes.