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Bimodal peaks of liver stiffness in a case of drug-induced liver injury.
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Description
<jats:p>A 69‐year‐old male complained of general fatigue and presented with elevation of liver enzymes without any cause of liver injury. We diagnosed him with hepatocellular drug‐induced liver injury (<jats:styled-content style="fixed-case">DILI</jats:styled-content>). Liver stiffness, which was evaluated according to the shear wave velocity (<jats:styled-content style="fixed-case">SWV</jats:styled-content>) using virtual touch tissue quantification, was serially observed during hospitalization. A fast <jats:styled-content style="fixed-case">SWV</jats:styled-content> was noted on the date of admission, indicating a “hard” degree of liver stiffness. The <jats:styled-content style="fixed-case">SWV</jats:styled-content> gradually decreased until the 20th hospital day. However, the patient's liver enzymes again became elevated on the 20th hospital day, and the <jats:styled-content style="fixed-case">SWV</jats:styled-content> simultaneously increased in association with a rise in the total bilirubin level. The laboratory data for the second peak of the <jats:styled-content style="fixed-case">SWV</jats:styled-content> indicated mixed‐type <jats:styled-content style="fixed-case">DILI</jats:styled-content>; therefore, the patient's pathological state transitioned from the hepatocellular type to the mixed type. A liver biopsy performed before discharge revealed a state of recovery from acute inflammation without fibrotic changes. We conclude that the second peak of the <jats:styled-content style="fixed-case">SWV</jats:styled-content> <jats:italic>may be</jats:italic> affected by the presence of intrahepatic cholestasis. We herein report the occurrence of bimodal peaks of liver stiffness in a patient with <jats:styled-content style="fixed-case">DILI</jats:styled-content>. In such cases, each peak of liver stiffness may be the result of a different pathological mechanism, namely acute inflammation versus acute intrahepatic cholestasis. Although the detailed mechanisms underlying the development of liver stiffness due to intrahepatic cholestasis remain unclear, this case presented a limitation of virtual touch tissue quantification for evaluation of liver stiffness as fibrosis marker in the liver with intrahepatic cholestasis.</jats:p>
Journal
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- Hepatology Research
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Hepatology Research 45 (3), 343-348, 2015-05
Wiley