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Case Reports
. 2016 Dec 20;10(1):370.
doi: 10.1186/s13256-016-1152-8.

Rare presentation of subcapsular hepatic steatosis in a woman with uncontrolled diabetes without peritoneal dialysis: a case report

Varun Chowdhary  1 , Jennifer S Golia Pernicka  2 , Richa Sharma  2
Affiliations
Case Reports

Rare presentation of subcapsular hepatic steatosis in a woman with uncontrolled diabetes without peritoneal dialysis: a case report

Varun Chowdhary et al. J Med Case Rep. .

Abstract

Background: Subcapsular hepatic steatosis is a rare atypical pattern of fatty deposition of the liver reported in patients with diabetic nephropathy receiving peritoneal dialysis with intraperitoneal insulin. To date, there has been only one pediatric and zero adult cases of subcapsular hepatic steatosis with no history of continuous ambulatory peritoneal dialysis. We report the first published case of subcapsular hepatic steatosis in an adult diabetic patient without any history of peritoneal dialysis or evidence of chronic renal disease.

Case presentation: A 46-year-old Caucasian woman with type 2 diabetes mellitus without renal disease presented to our emergency department with vague abdominal symptoms and vomiting. Her blood glucose levels were poorly controlled with a range of 400 to 500 mg/dL. She was diagnosed as having subcapsular hepatic steatosis based on magnetic resonance imaging. Of note, after improved glucose control her subcapsular hepatic steatosis had nearly resolved.

Conclusions: Subcapsular hepatic steatosis has been exclusively described in patients with continuous ambulatory peritoneal dialysis and those on intraperitoneal insulin, except for one pediatric case, which was probably due to incorrect insulin administration. Our case demonstrates that a diagnosis of subcapsular hepatic diagnosis should not be restricted to those getting continuous ambulatory peritoneal dialysis, but rather expanded to all patients with uncontrolled blood glucose levels.

Keywords: CT; Case report; Diabetes; Hepatic steatosis; In and out-of-phase; MR; Subcapsular.

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Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography of the liver in (a) axial and (b) coronal views. Multiple hypodense lesions are noted throughout the liver in a subcapsular distribution (arrows) as well as perivascular (circle)
Fig. 2
Fig. 2
Axial images through the liver confirm subcapsular steatosis as seen on computed tomography in Fig. 1. a Axial T1-weighted in-phase gradient echo magnetic resonance imaging (repetition time/echo time = 150/4.4) shows areas of hyperintensity in the subcapsular region (arrow). b Axial T1-weighted opposed-phase gradient echo magnetic resonance imaging (repetition time/echo time = 150/2.2) shows signal loss in the corresponding subcapsular regions (arrow)
Fig. 3
Fig. 3
Follow-up scan 3 months after the initial study (Fig. 1) demonstrates resolution of the geographic hypoattenuating areas. The patient underwent a stricter insulin regimen and education to reduce her average blood glucose levels. a Axial and b coronal views are shown
See this image and copyright information in PMC

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