A case of metabolic syndrome, positive antinuclear antibodies and cirrhosis.

Abstract

Metabolic syndrome is a common clinical condition often associated with hepatic steatosis and sometimes with mild transaminases and gamma-glutamyl transpeptidase increase. We report a case of a 45-years-old female, with mild increase of ALT, who was followed-up in our Department. A liver biopsy was then performed when an atorvastatin-induced ALT flare, as well as a positive antinuclear antibody appearance, occurred. A picture of steatohepatitis with sever fibrosis and cirrhosis was found. A caloric restriction with physical activity as well as the use of metformin were recommended. In the following 6 years the patient develops a decompensated cirrhosis and was referred to a Transplant Unit. This case suggests that non alcoholic steatohepatitis and cirrhosis can develop in patients with metabolic syndrome, especially when other cofactors of liver damage, as alcohol, may be superimposed. In non alcoholic steatohepatitis liver biopsy is mandatory to stage the disease. Moreover it is always recommended when different causes may concur to liver damage in the same patient.