Neonatal intrahepatic cholestasis with hepatic siderosis and steatosis.
Neonatal intrahepatic cholestasis is a heterogeneous disease of undetermined cause. There is an unreported subset of idiopathic neonatal intrahepatic cholestasis with an unusual histological combination of hepatic siderosis and macrovesicular steatosis. The patients were a 34-day-old female and a 39-day-old male with normal birth weights. Their mothers had received oral iron supplement 4-6 weeks before delivery. The patients had obstructive jaundice noticed at the well-baby clinic at 1 month of life. They had high levels of serum galactose and tyrosine, hyperferritinemia. Urinary organic acid and bile acid analyses were negative, and galactose-1-phosphate uridyltransferase activity in red cells was normal. Liver biopsies showed diffuse iron deposits and macrovesicular fat. By substituting formula milk with lactose-free milk, the patients responded, and had normal biochemical tests within 5 months of life. Follow-up biopsies, at the age of 12 months, showed mild residual fibrosis without iron or fat deposits. They are both well at 3 and 6 years of age, respectively, without biochemical liver dysfunction and neurologic impairment. Prenatal iron-overload might contribute to the pathogenesis of the disease, but further studies are needed to confirm the assumption.
Tazawa
Y
Y
Department of Pediatrics, Akita University School of Medicine, Japan.
Nishinomiya
F
F
Abukawa
D
D
Aikawa
J
J
Ohura
T
T
Tohma
M
M
Watanabe
A
A
Suzuki
T
T
Takada
G
G
Konno
T
T
D002780:Cholestasis, Intrahepatic / Q000150:complications*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000378:metabolism*; D008297:Male; D012806:Siderosis / Q000150:complications*