Non-Alcoholic Steatohepat...

A 48-year-old female with a medical history of hypertension and diabetes mellitus, taking glimepiride, metformin hydrochloride, and amlodipine besilate was admitted to the emergency department in 2004 for histological examination of fatty liver. She had a BMI of 48 and no history of alcohol intake. The patient's laboratory results showed normal levels of liver enzymes (AST and ALT), slightly elevated fasting blood sugar (121 mg/dl), and HbA1c levels (6.6%), indicating hyperglycemia and possible diabetes, and decreased levels of Hb (10.8 g/dl) and platelets (23.8×104/μl). The patient was negative for hepatitis C and B. Ultrasound (US) and plain computed tomography (CT) revealed fatty liver with no fibrosis or inflammation. Between 2004 and 2007, the patient's AST and ALT levels varied from 14 to 126 IU/ml and 12 to 41 IU/ml, respectively. During this time, the patient took no antioxidants such as vitamin E or ursodeoxycholic acid. Upon readmission in May 2007 for liver histological examination, the patient had a body weight of 100kg and a BMI of 44. Laboratory results showed AST levels of 50 IU/l, ALT levels of 27 IU/l, FBS levels of 85 mg/dl, HbA1c levels of 7.2%, hyaluronic acid levels of 111 ng/ml, WBC count of 5300 /μl, and PLT count of 21×104/μl. Plain CT revealed severe fatty liver with an L/S ratio of 0.75. A US-guided liver biopsy was performed. (Figures 1a and 1b).