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Dear Editor: A 34 year old woman, previously healthy and on no medications or supplements, presented with a 5 week history of fatigue and jaundice. She denied alcohol or illicit drug use. She had no encephalopathy or ascites, and transaminases were 8 times normal, gamma-glutamyl transpeptidase 9 times normal, alkaline phosphatase 3 times normal, INR 1.7 (normal 0.9-1.1), MCV 97 fL (normal 80-98 fL) and bilirubin and conjugated bilirubin both above upper limit of detection (570 and 180 umol/L, respectively; normal 3.4-17.1 and < 5.1 umol/L, respectively). Viral and autoimmune serologies, liver imaging, pregnancy screen, slit lamp exam, and urine copper studies were negative. Liver biopsy revealed severe active steatohepatitis with no fibrosis. Blood acetaminophen level was 5 times the therapeutic limit by colorimetric assay. She received N-acetyl cysteine (NAC) while awaiting a confirmatory assay for acetaminophen with gas chromatography/mass spectrometry (GC-MS) that was negative. She later admitted to consuming 50 units of alcohol daily in the week prior to the onset of her illness, and she gradually improved with abstinence from alcohol.

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2011-03-30   |   665 visitas   |   Evalua este artículo 0 valoraciones

Vol. 10 Núm.2. Abril-Junio 2011 Pags. 239-240 Ann Hepatol 2011; 10(2)