Pasteurella multocida septicaemia associated with chronic liver disease.

1 June (day 1) her serum, which was being checked routinely every two weeks, contained HBsAg, subtype adw, and the transaminases had risen slightly, but were still within normal limits.Nausea, vomiting, and upper abdominal discomfort then developed and on day 11 she was admitted to hospital.By then she had no complaints.There was no history of arthralgia, exanthema, skin eruptions, or fever, nor of intolerance to fat or tobacco.She did not use any medication.Her father had had a polyneuropathy complicating diphtheria in 1930.Physical examination showed jaundice and a tender, 1-cm palpable, liver.The spleen was not palpable and there were no spider nevi or liver palms.The highest values of serum alanine transaminase (SGPT) were recorded on day 11, and of serum bilirubin and smooth muscle antibody (SMA) on day 14.A liver biopsy performed on day 15 showed features of acute hepatitis, including extensive confluent necrosis of hepatocytes and portoportal bridging.Immunofluorescence for HBsAg was negative.Treatment consisted of absolute bedrest.