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An otherwise healthy 70-year-old man presented with abrupt onset of fever and abdominal pain. His medication history included aspirin and acetaminophen. Laboratory studies showed marked elevation of AST and ALT (>1000 U/L) and an abnormal coagulation profile. Serological studies for hepatitis A, B and C as well as autoantibodies were negative. Renal failure and encephalopathy developed, and the patient died. An autopsy showed an enlarged liver with extensive hemorrhagic necrosis.
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• Acetaminophen toxicity
• Acute ischemic necrosis
• Budd-Chiari syndrome
• Fulminant Wilson disease
• Herpes simplex virus hepatitis
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