title: Morbidly obese patient with non-alcoholic steatohepatitis-related cirrhosis who died from sepsis caused by dental infection of Porphyromonas gingivalis: A case report.
abstract: Non-alcoholic steatohepatitis (NASH) is associated with increased risks of developing lifestyle-related diseases including type 2 diabetes, cardiovascular disease and cerebral vessel disease. While the two-hit hypothesis and, recently, multiple parallel hits hypothesis of NASH pathogenesis were proposed, further details have not emerged. Recently, dental infection of Porphyromonas gingivalis (P. gingivalis) has been reported as a critical risk factor for NASH progression, which acts as multiple parallel hits to induce inflammation and fibrogenic responses in steatosis. We describe here a 54-year-old woman who died from sepsis and was diagnosed with NASH. Briefly, her body mass index (BMI) at the age of 35 years old had been 25.6 kg/m(2) , but she became obese after withdrawing into her home at the age of 45 years. Severe obesity continued over 19 years without diabetes mellitus. She was admitted to our hospital due to a sudden disturbance of consciousness. On admission, her BMI was 48.5 kg/m(2) . Computed tomography revealed cirrhotic liver with massive ascites, and laboratory data indicated increased inflammatory responses, renal failure and C grade Child-Pugh classification, suggesting the diagnosis of sepsis. Also, severe periodontal disease was present, because the patient's front teeth fell out easily during intubation. Although the focus of infection was not specified, the oral flora Parvimonas micra, a periodontal pathogen, was detected in venous blood. In spite of intensive care including artificial respiration management and continuous hemodiafiltration, she died on the 43rd day after admission. Surprisingly, P. gingivalis was detected in her hepatocytes. This case may represent the significance of P. gingivalis in the progress to cirrhosis in NASH patients.
authors.affiliation: Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yuno
authors.initials: Y
authors.lastname: Omura
authors.affiliation: Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Mikiya
authors.initials: M
authors.lastname: Kitamoto
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hyogo
authors.affiliation: Emergency Care, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Yamanoue
authors.affiliation: Emergency Care, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Emergency Care, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Boku
authors.affiliation: Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishisaka
authors.affiliation: Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Miyauchi
authors.affiliation: Department of Oral and Maxillofacial Pathobiology, Basic Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Takata
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
keywords: Porphyromonas gingivalis; dental infection; non-alcoholic steatohepatitis; oral flora