A Rare Case of Giant Cell Hepatitis Superimposed on Sickle Cell Hepatopathy

Giant cell hepatitis (GCH) is a rare histopathologic pattern of liver injury characterized by multinucleated syncytial hepatocytes within inflamed parenchyma and is a pattern most commonly seen in infants rather than adults. We report a case of levofloxacin-induced GCH superimposed on sickle cell hepatopathy in a 20-year-old woman with sickle cell disease. She presented with recurrent transaminitis and severe hyperbilirubinemia shortly after initiation of levofloxacin. Liver biopsy revealed sinusoidal congestion and fibrosis consistent with sickle cell hepatopathy, along with portal inflammation, bile duct injury, and multinucleated hepatocytes diagnostic of GCH. Prednisone therapy was started, which led to marked biochemical and histologic improvement, and subsequent resolution of GCH on repeat biopsy. This case emphasizes the diagnostic utility of liver biopsy in sickle cell disease in medical management.