Hypertransaminasemia in poorly-controlled type-1 diabetes mellitus

Abstract

A 16-year-old boy had been diagnosed with type-1 diabetes mellitus at the age of 9 with no subsequent appropriate metabolic control (HbA1c: 10-11%). He presented frequent hypoglycemic episodes and required hospitalization in several occasions because of vomiting and ketoacidosis. His weight and height were in low percentiles (BMI: 21.1 kg/m 2) for his age and laboratory data did not disclosed any abnormality except those related with the diabetes. While remaining asymptomatic, an ordinary laboratory test revealed abnormal liver function parameters (AST/ALT: 578/526 U/l, GGT: 284 U/l) and a raised lipid profile (cholesterol/triglycerides 225/223: mg/dl). An initial study yielded negative results (virus serologic tests, autoantibodies, electrophoresis, complement, alpha1 antitrypsin, and celiac disease screening tests). For the following 8 months, the patients remained asymptomatic, although with a bad control of the diabetes and elevated serum levels of aminotransferases (AST 59-227 IU/l, ALT 68-120 IU/l y GGT 53-120 IU/l). At that moment, physical examination revealed the presence of a hepatomegaly and a new investigation demonstrated positive ANA (1/640), but other autoantibodies were (SMA, LKM-1, AMA) negative. His HLA haplotype was DR4. Abdominal ultrasonography demonstrated a diffuse hyperechogenic liver suggestive of fatty infiltration. A liver biopsy revealed a normal liver architecture with mild inflammatory infiltrates in some portal tracts and