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Z Gastroenterol 2020; 58(01): 57-62
DOI: 10.1055/a-1062-8788
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© Georg Thieme Verlag KG Stuttgart · New York

A young patient with type 2 diabetes associated non-alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma

Ein junger Patient mit Typ-2-Diabetes assoziierter nichtalkoholischer Steatohepatitis, Leberzirrhose und hepatozellulärem Karzinom
Maurice Michel
1   Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Eva Kalliga
1   Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Christian Labenz
1   Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Beate K. Straub
2   Institute of Pathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Marcus-Alexander Wörns
1   Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Peter R. Galle
1   Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
,
Jörn M. Schattenberg
1   Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
› Author Affiliations
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Publication History

Publication Date:
13 January 2020 (online)

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Abstract

The rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.

Zusammenfassung

Die zunehmende Prävalenz des metabolischen Syndroms hat zu einem Anstieg der nichtalkoholischen Fettlebererkrankung (NAFLD) sowie ihrer progressiv-inflammatorischen Form, der nichtalkoholischen Steatohepatitis (NASH), geführt. In den letzten Jahren sind die NAFLD und die NASH weltweit zu bedeutenden Risikofaktoren der Leberzirrhose und des hepatozellulären Karzinoms (HCC) geworden. In diesem Fall berichten wir über einen 46-jährigen Patienten mit Diabetes mellitus Typ 2 und metabolischen Komorbiditäten, Übergewicht und arterieller Hypertonie, der zur Abklärung von erhöhten Leberwerten überwiesen wurde. Nach klinischer sowie diagnostischer Aufarbeitung des Falls konnte die Diagnose einer NASH-assoziierten Leberzirrhose Child-Pugh B gestellt werden. Die Blutzuckereinstellung war schwer zu erzielen, der Patient stellte sich wiederholt mit hohen HbA1c-Werten sowie schlechtem Ansprechen und einer Unverträglichkeit auf eine Insulintherapie vor. Aufgrund der Leberzirrhose wurde der Patient in das HCC-Vorsorgeprogramm aufgenommen. Im Rahmen der sonografischen Kontrolle wurde eine fokale Läsion der Leber entdeckt. Im MRT konnte die Diagnose eines HCC (BCLC Stadium A) anhand des charakteristischen Kontrastmittelverhaltens bestätigt werden. Der Patient wurde bei einem labMELD von 17 Punkten zur Lebertransplantation evaluiert und einer intermittierenden TACE-Behandlung unterzogen. Die Transplantation konnte erfolgreich durchgeführt werden. Nur zwei Monate später entwickelte der Patient jedoch schwere Komplikationen, die letztlich zum Versterben führten. Insgesamt zeigt dieser Fall die verschiedenen medizinischen Probleme von Patienten mit metabolischem Syndrom, die eine chronische Lebererkrankung entwickeln. Bei diesem Patienten war – trotz des jungen Alters – eine schnelle Progression der NASH-assoziierten Leberzirrhose zum HCC zu sehen; und dies betont daher die Bedeutung einer engmaschigen Beobachtung, um potenzielle Risiko- sowie Progressionsfaktoren frühzeitig im Krankheitsverlauf zu identifizieren und positiv zu beeinflussen.

Key words

NASH - liver cirrhosis - HCC - type 2 diabetes - metabolic syndrome

Schlüsselwörter

NASH - Leberzirrhose - HCC - Typ 2 Diabetes - metabolisches Syndrom
 

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