Persistent active hepatic necrosis with the enigmatic absence of abnormalities in laboratory test results

Certain common clinical laboratory tests are employed regularly to determine the presence of active necrotizing processes in the liver. These include in particular bilirubin, several enzymes, clotting factors, and serum proteins. We have studied a patient with perihepatic and intrahepatic infection and extensive necrosis, who showed minimal changes in the usual biochemical markers associated with hepatocellular damage. The significance of these findings is discussed.