Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition
Journal
Modern Pathology
Journal Volume
30
Journal Issue
6
Pages
834-842
Date Issued
2017
Author(s)
Abstract
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. ? 2017 USCAP, Inc All rights reserved.
Other Subjects
immunoglobulin M; adult; Article; brain disease; clinical article; clinical feature; demography; Epstein Barr virus; female; flapping tremor; hepatomegaly; histopathology; human; human tissue; hypoalbuminemia; jaundice; liver biopsy; liver dysfunction; liver transplantation; low carbohydrate diet; malnutrition; medical history; middle aged; nonalcoholic fatty liver; priority journal; protein diet; Roux-en-Y gastric bypass; severe hepatic impairment; starvation; tissue section; weight reduction; body weight loss; differential diagnosis; disease exacerbation; gastric bypass surgery; liver; malnutrition; mortality; nonalcoholic fatty liver; nutritional status; pathology; pathophysiology; predictive value; risk factor; time factor; treatment outcome; Adult; Diagnosis, Differential; Diet, Carbohydrate-Restricted; Diet, High-Protein; Disease Progression; Female; Gastric Bypass; Humans; Liver; Liver Transplantation; Malnutrition; Middle Aged; Non-alcoholic Fatty Liver Disease; Nutritional Status; Predictive Value of Tests; Risk Factors; Time Factors; Treatment Outcome; Weight Loss
Publisher
Nature Publishing Group
Type
journal article