title: Dubin-Johnson-like black liver with normal bilirubin level.
abstract: Black liver is a common finding in Dubin-Johnson syndrome (DJS), which is caused by the lack of multidrug resistance-associated protein 2 (MRP2). Impaired excretion of epinephrine metabolites is believed to be a cause of black liver in DJS. Recently, we experienced a patient with black liver whose serum bilirubin level was normal. Coarse brown granules were observed in the hepatocytes, and this finding closely resembled that observed in DJS. However, the granules were negative for Schmorl staining. The MRP2 gene did not show any mutation. Immunostaining study demonstrated MRP2 protein expression in the liver, and it was localized in the canalicular membranes of hepatocytes. This case illustrates for the first time that DJS is not the only cause of black liver.
authors.affiliation: Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Japan.
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ishihara
authors.forename: Morimasa
authors.initials: M
authors.lastname: Wada
authors.forename: Susumu
authors.initials: S
authors.lastname: Kajihara
authors.forename: Jun
authors.initials: J
authors.lastname: Araki
authors.forename: Rumi
authors.initials: R
authors.lastname: Mifuji
authors.forename: Toshio
authors.initials: T
authors.lastname: Itani
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
authors.forename: Fumihito
authors.initials: F
authors.lastname: Urawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kaito
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Adachi
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D001774:Blood Chemical Analysis; D003116:Color; D004252:DNA Mutational Analysis; D022781:Hepatocytes / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D007566:Jaundice, Chronic Idiopathic / Q000097:blood* / Q000235:genetics; D008099:Liver / Q000378:metabolism; D008297:Male; D026901:Membrane Transport Proteins / Q000235:genetics / Q000378:metabolism*; D000089762:Multidrug Resistance-Associated Protein 2; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000235:genetics / Q000378:metabolism*; D012835:Silver Nitrate
chemical_list: D001663:Bilirubin; D026901:Membrane Transport Proteins; D000089762:Multidrug Resistance-Associated Protein 2; D027425:ATP-Binding Cassette, Sub-Family C Proteins; D012835:Silver Nitrate; C000715087:ABCC2 protein, human; C051037:Fontana-Masson stain