Dubin-Johnson-like black liver with normal bilirubin level.
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.
Kobayashi
Yoshinao
Y
Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Japan.
Ishihara
Tomoaki
T
Wada
Morimasa
M
Kajihara
Susumu
S
Araki
Jun
J
Mifuji
Rumi
R
Itani
Toshio
T
Kuroda
Makoto
M
Urawa
Fumihito
F
Kaito
Masahiko
M
Adachi
Yukihiko
Y
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
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