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Case Reports
. 2018 Apr 15;57(8):1087-1092.
doi: 10.2169/internalmedicine.9490-17. Epub 2017 Dec 27.

Glycogenic Hepatopathy in Type 1 Diabetes Mellitus

Shohei Asada  1 , Hideto Kawaratani  1 , Tsuyoshi Mashitani  1 , Daisuke Kaya  1 , Maiko Nishigori  1 , Takuya Kubo  1 , Yasuhiko Sawada  1 , Yukihisa Fujinaga  1 , Kosuke Kaji  1 , Mitsuteru Kitade  1 , Tadashi Namisaki  1 , Kei Moriya  1 , Akira Mitoro  1 , Hitoshi Yoshiji  1
Affiliations
Case Reports

Glycogenic Hepatopathy in Type 1 Diabetes Mellitus

Shohei Asada et al. Intern Med. .

Abstract

Glycogenic hepatopathy (GH) is a rare complication of poorly controlled type 1 diabetes mellitus (T1DM), and is characterized by elevated liver enzymes, hepatomegaly, and glycogen accumulation. We herein present the case of a 23-year-old man with poorly controlled T1DM who had liver dysfunction. Imaging studies showed severe hepatomegaly and fatty liver. The examination of a liver biopsy specimen revealed fatty droplets, ballooning, inflammation, and mild fibrosis. Subsequent periodic acid-Schiff (PAS) staining after diastase digestion confirmed GH. In this case, the improvement of hyperglycemia, not HbA1c, resulted in the improvement of the patient's liver function. This is the first report on the use of continuous glucose monitoring in patients with GH to show that continuous hyperglycemia may worsen GH.

Keywords: glycogenic hepatopathy; hepatomegaly; periodic acid-Schiff staining; poorly controlled type 1 diabetes mellitus.

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Figures

Figure 1.
Figure 1.
(A, B) Ultrasound images showing severe hepatomegaly and fatty liver.
Figure 2.
Figure 2.
(A, B) Contrast-enhanced computed tomography scans showing severe hepatomegaly and fatty liver. (C, D) Computed tomography scans after the improvement of the liver function, showing the improvement of hepatomegaly and fatty liver.
Figure 3.
Figure 3.
Staining of the liver biopsy specimen. (A) Slight inflammation in the portal area, and mild intralobular inflammation [Hematoxylin and Eosin (H&E) staining, magnification ×40]. (B) Slight centrilobular ballooning of the hepatocytes (H&E staining, magnification ×100). (C) Mild pericellular fibrosis (azan staining, magnification ×40).
Figure 4.
Figure 4.
Periodic acid-Schiff (PAS) staining of the liver biopsy specimen. (A) Many PAS-positive granules were observed within the cytoplasm of the hepatocytes (magnification ×40). (B) The disappearance of PAS-positive granules after diastase digestion (magnification ×40).
Figure 5.
Figure 5.
Changes of AST, ALT, and GGT.
See this image and copyright information in PMC

Comment in

References

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