We present the case of a 27-year-old man who was first diagnosed with type 1 diabetes mellitus when he presented with diabetic ketoacidosis (DKA) and during later admissions was found to have grossly abnormal liver function tests. Following diagnosis, his diabetic control has been a challenge to manage despite the patients claim he had been taking his insulin religiously. He has had repeated admissions with DKA and has failed to attend clinic follow-ups on several occasions. Optimum support was offered by the diabetes specialist nurse and dietitian. However, the outcome remained unfavourable with poor glycaemic control and repeated hospital admissions with DKA.
Two years after being diagnosed with diabetes, liver function tests were found to be deranged during a hospital admission with DKA. Gross hepatomegaly was found on examination and confirmed on abdominal ultrasound. Screening for infective, metabolic, and autoimmune causes were all normal. A liver biopsy was performed under ultrasound guidance. Histopathology demonstrated features of pale swollen hepatocytes with glycogen deposition consistent with glycogenic hepatopathy. Improvements in glycaemic control correlated well with alteration in liver enzyme levels. Despite the grossly elevated liver enzymes and the substantial hepatomegaly the prognosis is good with progression of liver disease unlikely.
We are reporting this case to highlight an uncommon and often unrecognised cause of abnormal LFTs in individuals with poorly controlled type 1 diabetes. The features of this condition and theories of the pathogenesis are discussed illustrated by this case report.