Glycogenic hepatopathy as a cause of severe deranged liver enzymes in a young patient with type 1 diabetes mellitus

Abstract

Glycogenic hepatopathy (GH) is a rare complication of poorly controlled type 1 diabetes mellitus (T1DM). We present a 19-year-old woman with T1DM and autoimmune thyroiditis who admitted to our department because of abrupt onset intermittent abdominal pain in the right upper quadrant accompanied by laboratory evidence of acute anicteric hepatitis. Physical examination revealed significant hepatomegaly but the common imagining studies were negative. Following exclusion of common causes of acute hepatitis and because of the presence of smooth muscle antibodies in a young female patient with already established two autoimmune diseases, a liver biopsy was performed in order to exclude the potential presence of autoimmune hepatitis. However, liver histology showed typical findings of GH. Intense treatment targeting strict glycemic control resulted in normalisation of liver biochemistry. This case underlines that GH should be considered as a rare cause of acute hepatitis in T1DM patients with poor glycemic control.

Keywords: diabetes; hepatitis other; metabolic disorders; pathology.

Figure 1

The hepatocytes show clear cytoplasm with distinct cytoplasmic membranes. There is no steatosis. (A) Original magnification H&E 10×; (B) original magnification H&E 40×.

Figure 2

(A) Intense cytoplasmic staining is seen in PAS stain (original magnification 40×). (B) Loss of cytoplasmic staining in PAS diastase stain, consistent with accumulation of glycogen (original magnification 40×). PAS, periodic acid–Schiff stain.