Three cases of glycogenic hepatopathy mimicking acute and relapsing hepatitis in type I diabetes mellitus
A 20-year old female with type I DM during 10 years was referred to a hepatologist for elevated liver enzymes. When she visited our hospital 8weeks ago, her AST and ALT levels were within normal range as 13 and 9 U/L, respectively. At the time of the referral, her AST and ALT were elevated strikingly to 1,310 U/L and 346 U/L. Other laboratory finding such as TB (0.2 mg/dL), ALP (132 U/L), γ-GT (15 U/L), TG (112 mg/dL), HDL (36 mg/dL), CK 86 UL, thyroid function test, serum ceruloplasmin level were all normal. ANA, ASMA and AMA were also negative. The serologic findings for viral infection were also all negative. There was no history of taking alcohol or drug except insulin. Her glycemic control had been poor and HbA1c was 13.6%. Her height, weight, body mass index (BMI) and waist circumference were 149.8 cm, 47.1 kg and 21 kg/m2, respectively. Abdominal US showed just a mild fatty change of liver. As former two cases, she did not show any symptom and sign compatible with acute hepatitis and GH was confirmed by liver biopsy. During the follow up, her glycemic control has been still poor and HbA1c has been maintained above 15%. However, her liver enzyme levels have shown dramatically down and maintenance within normal range ().