Possible explanations for the patient's acute deterioration
| Differential diagnosis | Pro | Con |
|---|---|---|
| Related to liver biopsy: | ||
| (a) Bleed into capsule or abdomen | • Temporal relation with biopsy | • No abdominal pain |
| • Speed of deterioration | • No change in abdominal girth | |
| • Marked intravascular volume depletion | • No drop in haemoglobin | |
| (b) Sepsis | • Temporal relation | • Lack of positive cultures |
| • Fever preceding deterioration | ||
| • Hypovolaemia and acidosis | ||
| Intercurrent problems: | ||
| Nosocomial infection | • Temporal association with biopsy | |
| HAART associated | • Patient immunosuppressed | |
| Mitochondrial toxicity | • Previous exposure to HAART | • No steatosis on liver ultrasound |