History—A 15 year old patient from Guadeloupe (French Indies) was assessed for liver transplantation, having developed acute liver insufficiency after a week of flu-like illness and jaundice.

Investigations—Viral hepatitis serology (hepatitis A, B, non A-non B), herpes virus simplex, Ebstein-Barr virus, cytomegalovirus, and sequential tests for haemorrhagic fever viruses (dengue, chikungunya, yellow fever, Japanese encephalitis, and West Nile) were negative. Ultrasonography showed a heterogeneous liver with multiple large hyperechogenic zones disseminated to all hepatic segments. Transjugular liver biopsy showed preserved liver architecture, numerous and diffuse foci of hepatocyte necrosis, affecting all zones randomly, in association with few Councilman bodies. These foci of non-zonal necrosis contained minor inflammatory changes with …