I’ve seen a lot of hepatic fibrosis over the past few decades. Mostly it’s been portal-to-portal fibrosis, and occasionally portal-to-venule. But I very rarely see venule-to-venule fibrosis. This is a case of a young-middle-age male with a long history of intravenous drug use and hepatitis C who died of a methamphetamine and fentanyl overdose (one of the two or three I see every day I do autopsies). In this case there were multiple examples of venule-to-venule fibrosis: