Cholestatic pattern of li...

A 35-year-old female had poorly controlled type 1 diabetes mellitus. She was noted to have abnormal liver enzymes with a cholestatic pattern. Liver ultrasound and biopsy were normal. Her liver enzymes remained abnormal for 13 years. Later she presented with hyperglycaemia, diabetic nephropathy, and retinopathy. She was cachexic and weighed 43 kgs and BMI of 18. Glycaemic control was poor, with an HbA1c of 14%. Her alkaline phosphatase was 4338 U/I; gamma glutaryl transferase was 310 U/I; her aspartate transferase was 110 U/I. Her serum bilirubin was 7 umol/l, serum albumin 30g/l, ad prothrombin ratio 1.1. A repeat liver ultrasound was normal with neither gallstones nor intra-hepatic/extra-hepatic bile duct dilation. The patient denied any herbal toxin ingestion. Her serum vitamin A and beta carotene levels were normal, and she had never had radiotherapy. Serology did not show active viral hepatitis A repeat liver biopsy was performed.