We report the case of a 28-year-old woman with long-standing type 1 diabetes, treated with insulin and poorly controlled blood glucose (HbA 1, 10.5%), who was referred to our service due to abdominal pain.
She did not report toxic habits, use of other drugs or any history of interest.
Physical examination revealed a weight of 54 kg, height of 1.64 cm and abdominal circumference less than 80 cm (BMI 20).
Hepatomegaly of 3-4 cm painful to palpation, without other alterations of interest.
Analytical studies showed a significant alteration of normal transaminase levels AST 1600 IU/L, ALT 534 IU/L, FA 44 IU/L, GGT 661 IU/L with and without liver function
He also had mild hypertriglyceridemia (250 mg/dl) and elevated LDL cholesterol (200 mg/dl) with normal HDL (66 mg/dl).
Ultrasound showed hepatomegaly and increased hepatic echogenicity suggestive of steatosis.
A complete study of liver disease was performed which was negative, ruling out the existence of entities such as viral hepatitis, autoimmune, hemochromatosis, alpha-1 antitrypsin deficiency or Wilson's disease.
The most probable differential diagnosis between glycogen hepatopathy or nonalcoholic steatohepatitis was established.
These findings were confirmed by liver biopsy under ultrasound guidance.
Histology showed pale hepatocytes, swelling of the cytoplasm with compression of sinusoids and glycogenized nuclei in a high number of them.
The presence of steatosis in small amounts without necrosis, inflammation or structural damage was also described.
Staining periodic acid-Schiff (PAS) showed abundant intracytoplasmic glycogen, consistent with the diagnosis of glycogen liver disease.
