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Mod Pathol. 2017 Jun;30(6):834-842. doi: 10.1038/modpathol.2017.13. Epub 2017 Mar 3.

Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition.

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Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Pathology, University of California, San Francisco, CA, USA.
Genomic Health, Redwood City, CA, USA.
Department of Pathology, University of Washington, Seattle, WA, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA, USA.


While non-alcoholic steatohepatitis is a slowly progressive disease, patients may rarely present in acute liver failure. We describe six patients who developed severe hepatic dysfunction following rapid weight loss or malnutrition. Rapid weight loss (18 to 91 kg) occurred after Roux-en-Y gastric bypass in four patients and starvation-like dieting or hypoalbuminemia was noted in two patients. Four patients either died or received an urgent liver transplant. Pathologic findings were characterized by advanced alcoholic steatohepatitis-like features, including extensive/circumferential centrizonal pericellular fibrosis, central scar with perivenular sclerosis/veno-occlusion with superimposed hepatocellular dropout, abundant/prominent hepatocellular balloons, and numerous Mallory-Denk bodies, but there was no history of excess alcohol consumption. This study characterizes clinicopathologic features of aggressive non-alcoholic steatohepatitis following rapid weight loss or malnutrition, which should be included in the differential diagnosis with alcohol when a patient is considered for liver transplantation. The mechanism of liver injury in aggressive steatohepatitis is unknown, but rapid fat mobilization in obese patients may potentially cause oxidative stress to the liver and further study is needed to determine if there is a genetic predisposition to this form of injury and if antioxidants may protect the liver during rapid weight loss/malnutrition.

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