This anticonvulsivant drug which commonly causes lymphadenopathy, polyarteritis nodosa and bone marrow damage more rarely causes cinical hepatitis. Presence of a large Histiocytic g ranuloma, sharply demarcated, without necrosis. Daily small doses are more dangerous than weekly large doses. The treatment must be monitored with repeat liver biopsies. There are no good alternatives to liver biopsies.
Biochemical tests are insufficient for assessing the hepatic injury.
This is the earliest lesion. Thre are foci of macrovesicular steatosis. Another case, advanced lesion. Another case, Late lesion. Besides the above illustrated cellular changes, in this case there is fibrosis, portal, periportal and porto-portal in some areas.