title: Hepatic subcapsular steatosis in a diabetic CAPD patient receiving intraperitoneal insulin.
abstract: Hepatic subcapsular steatosis is a rare and specific form of fatty change in the liver. It is a unique finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin causes a unique pattern of fatty infiltration in the subcapsular location of the liver. Here we report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who received intraperitoneal insulin. A 46-year-old diabetic woman on CAPD presented with general weakness. The patient received a total amount of 110 units of regular insulin via intraperitoneal and subcutaneous injection. Her initial blood chemistry showed increased serum lipid and liver enzyme profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We assumed that the cause was CAPD and concomitant intraperitoneal insulin treatment; therefore, the patient was switched from CAPD to hemodialysis (HD) and began to receive insulin subcutaneously. Two months after the beginning of HD, the hepatic subcapsular steatosis completely resolved.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Eun Chul
authors.initials: EC
authors.lastname: Jang
authors.forename: Guilsun
authors.initials: G
authors.lastname: Kim
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Sun Ae
authors.initials: SA
authors.lastname: Yoon
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Ku
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Kim
mesh_terms: D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016903:Drug Monitoring; D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007274:Injections, Intraperitoneal; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*
chemical_list: D007328:Insulin