PMC7691027_01
Clinical course. The AST level was increased to 30-50 U/L, ALT to 50-100 U/L, and gamma-GTP to 100 U/L until 21 years of age (201X-1 year). After the administration of bezafibrate at 22 years of age (201X year), the transaminase levels increased (AST, 86 U/L; ALT, 219 U/L; and gamma-GTP, 399 U/L) and the patient was admitted to our hospital. Treatment with ursodeoxycholic acid and Stronger Neo-Minophagen  C (SNMC ) was started and the transaminase levels decreased. However, the transaminase levels again became elevated after tapering SNMC  treatment and the patient required hospitalization on two occasions.
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At 22 years of age, bezafibrate was started and his transaminase levels improved after 2 weeks of treatment (Fig. 1).
Abdominal ultrasound and CT findings. a) Abdominal ultrasound and b, c) CT scans. Fibrosis of the liver was indicated by abdominal ultrasound and CT, but there was no evidence of fat accumulation (a, b). The visceral fat area estimated by CT was 166.55 cm2, suggesting visceral obesity (c). The liver-to-spleen attenuation ratio was 1.18. CT: computed tomography
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The ultrasound and CT findings showed fibrosis of the liver, but there was no evidence of fatty liver (Fig. 2a, b). The visceral fat area estimated by CT was 166.55 cm2, and the patient showed visceral obesity (Fig. 2c).
Pathological liver findings. Liver biopsy revealed mild microvesicular steatosis (arrow), with severe hydropic changes in the hepatocytes based on Hematoxylin and Eosin staining. Inflammation was mild. Fibrosis was mild on silver impregnation staining.
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Liver biopsy revealed mild microvesicular steatosis with severe hydropic changes of hepatocytes (Fig. 3).