Glycogenic hepatopathy associated with type 1 diabetes mellitus as a cause of recurrent liver damage.
Aminotransferase elevation is a frequent cause of consultation for the Hepatologist, in both the outpatient and inpatient settings, but identifying the origin of these biochemical alterations may be challenging. Here we report a case where acute elevation of aminotransferases, associated with abdominal symptoms, was the cause of two hospitalizations in a short period of time. As the patient suffered from type 1 diabetes, celiac disease, and autoimmune thyroiditis, several potential causes of damage could be hypothesized,  including celiac hepatitis, fatty liver, and autoimmune hepatitis. A liver biopsy performed in the occasion of the second hospitalization allowed to rule out autoimmune hepatitis and celiac hepatitis, showing mild signs of fatty infiltration. Staining with periodic acid-Schiff with or without diastase showed a marked accumulation  of  glycogen,  indicating  the  presence  of  a  glycogenic  hepatopathy  associated  with  poorly controlled type 1 diabetes. This condition may be a cause of liver damage in patients with type 1 and occasionally type 2 diabetes, but its occurrence is often overlooked. This case report illustrates the fact that glycogenic hepatopathy may relapse, and prompts the clinician to take into account this condition in the differential diagnosis of causes of liver injury.
Dipartimento di Medicina Interna, University of Florence, Italy.
Sara
S
Messeri
Luca
L
Messerini
Francesco
F
Vizzutti
Giacomo
G
Laffi
Fabio
F
Marra
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D048909:Diabetes Complications / Q000097:blood / Q000209:etiology* / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D006003:Glycogen / Q000378:metabolism*; D006801:Humans; D008099:Liver / Q000378:metabolism* / Q000473:pathology; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D010503:Periodic Acid-Schiff Reaction; D011237:Predictive Value of Tests; D012008:Recurrence
D015415:Biomarkers; D006003:Glycogen