Acute-on-chronicの重症型アルコール性肝障害の1例

概要

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We represent a 37-year-old man with sudden onset hepatic failure resulting from alcoholic liver cirrhosis. The patient was first admitted to Shiseikai 2nd Hospital for hematemesis caused by esophageal varices. He did not have any signs of viral hepatitis or serological features compatible with autoimmune liver disease. The patient's alcohol intake was around 0.8t (pure ethanol). Liver biopsy findings showed the formation of micronodules combined with hepatic fibrosis, the massive accumulation of microvesicular fat, and the presence of Mallory's hyaline bodies. These findings suggested alcoholic liver cirrhosis. With the secession of drinking, his liver function improved significantly. After the patient was discharged, he continued drinking alcohol and was re-admitted 12 months later. A second liver biopsy revealed massive hepatocyte necrosis and marked polymorphonuclear cell infiltration. Based on the appearance of the liver atrophy and the presence of disturbed consciousness and ascites, the patient was diagnosed with "acute-on-chronic" type hepatic failure caused by alcoholic hepatitis. While intesive hepatic care was performed, the patient died from hepatic failure. The necropsy specimen had a pseudolobular formation and exhibited multiple bile plugs in the micro bile ducts.
2001-01-25