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N Am J Med Sci. 2009 Jul;1(2):74-6.

Wilson's disease masquerading as nonalcoholic steatohepatitis.

Author information

1
Department of Internal Medicine & Clinical Research, Center for Liver Disease, Kawasaki Medical School, Kawasaki Hospital, Okayama, Japan.

Abstract

BACKGROUND:

Wilson's disease is one of the most common hereditary causes of unclear hepatopathy. PATIENT #ENTITYSTARTX00026;

METHOD:

A 34-year old male patient with a history of hyperlipidemia was admitted with symptoms of abdominal pain and slight hematuria. Abnormal liver function tests, ultrasound reports and liver biopsy were suggestive of nonalcoholic steatohepatitis (NASH). The patient received preliminary treatment for NASH. However, on subsequent follow-up, NASH remained unresolved and liver histology showed fibrosis progression from fibrosis stage 1 to stage 3.

RESULTS:

Biochemical tests revealed that the levels of serum ceruloplasmin were decreased (7mg/dl) while the urinary excretion of copper was found to be increased (174.2 μg/day). Wilson's disease was confirmed by diagnostic mutation analysis involving Direct Sequencing. Heterogeneity in the patient's ATP7B gene confirmed Wilson's disease. Administration of D-penicillamine resulted in a decrease in fat deposition in the liver and no further progression in fibrosis after 10 months.

CONCLUSION:

Adult patient presenting NASH as first symptoms need to be examined for Wilson's disease and other metabolic conditions affecting the liver, prior to initiation of treatment.

KEYWORDS:

Wilson's disease; hyperlipidemia; liver; non alcoholic fatty liver disease (NAFLD); nonalcoholic steatohepatitis (NASH); serum ceruloplasmin

PMID:
22666674
PMCID:
PMC3364654
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