Fibrosing cholestatic hepatitis: clinicopathologic spectrum, diagnosis and pathogenesis

Fibrosing cholestatic hepatitis (FCH) is a rapidly progressive, sometimes fatal form of liver injury. Though originally reported in liver transplant recipients with recurrent hepatitis B, it has now been recognized frequently in chronic hepatitis B or C patients who are under immunosuppression. The histopathologic hallmarks in the liver include marked hepatocytic injury, severe cholestasis, and periportal and pericellular fibrosis. The pathogenesis is largely unknown. The aim of this review is to describe the spectrum of clinical conditions in which FCH occurs, common histopathologic findings, features unique to certain underlying diseases, factors to be considered in differential diagnosis, and our current understanding of pathogenesis of this disease.