One hundred and eighty three icteric patients with biopsy proven acute viral hepatitis were selected for the study and were submitted to serial studies of liver needle biopsy, and clinical and laboratory examinations during the period from the early acute phase to the convalescent stage. Of these, 58 cases were available for long-term follow-up ranging from 3 to 10, years after the original attack. The majority of the cases (83%) healed to either normal or nonspecific reactive hepatitis within 3 months after the onset of jaundice.
In 13 per cent of the 143 patients, who were available for serial histologic studies, the histologic lesion subsided until only a little acute parenchymal changes remained after 3 months but all recovered within 1 year after the original attack. In an additional per cent, the transition of acute (or subacute) viral hepatitis into chronic liver diseases during 3 months of acute illness had been also observed by serial histologic study: postnecrotic cirrhosis in one, persisting portal inflammation in one and chronic active hepatitis of septal type in 4.
In the patient with postnecrotic cirrhosis, regression was achieved to a state of inactive incomplete septal fibrosis without any abnormal biochemical tests 3 years after, he initial study. The patient with persisting portal inflammation exhibited constant features without clinical, biochemical or histologic evidence of progression to cirrhosis 1 year after the acute attack. Three out of 4 patients with chronic active hepatitis of septal type were available for long-term follow-up. Of these, 2 appeared to have complete healing without cirrhosis. in the other, the histologic lesion failed to recover and ultimately progressed to an early stage of cirrhosis during the period of 3 years follow-up.
Abnormal clinical and laboratory features without association of significant organic hepatic lesion were observed in a sizable minority of patients who had recovered from acute viral hepatitis 3 to 10 years earlier. It does not appear that such abnormality is always a reason by itself for reinstituting bed rest or restricting activity.
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