A 32-year-old Obese Male with Prolonged Increased Transaminase Level Associated with Nash after Hbv Hepatitis

Nonalcoholic steatohepatitis (NASH) is an underdiagnosed liver disease and is the main cause of persistent elevated serum liver enzymes among the general population. Here, we report the case of a 32-year-old obese man who was diagnosed as a case of chronic hepatitis caused by HBV infection. He was treated with Lamivudine for two years. Though his HBV DNA load became negative, he had persistently elevated ALT and AST for two years. Then a liver biopsy was planned for greater diagnostic and prognostic certainty, as the patient was obese, and aspartate transaminase to alanine transaminase ratio was greater than one. The histopathology showed steatosis, ballooning degeneration, microinflammation and fibrosis compatible with non-alcoholic steatohepatitis. We present the case as we think that clinicians should be aware of the possibility, that hepatitis B viral hepatitis with prolonged elevated serum liver enzymes might be associated with non-alcoholic steatohepatitis. Keyword: Non-alcoholic fatty liver, steatohepatitis 1. Assistant Professor, Department of Medicine, DMCH 2. Post-graduate Trainee, Dept. of Medicine, BSMMU 3. Associate Professor, Department of Medicine, DMCH Correspondence : Dr. Ahmedul Kabir, Assistant Professor, Department of Medicine, DMCH occasional Mallory Bodies.1 A liver biopsy is required for its diagnosis as ultrasonography often misses the hepatic steatosis. Serum aminotransferases are elevated in most patients with NASH and they may have some degree of hepatomegaly but normal liver enzymes and a normal liver size do not exclude the diagnosis. Persistently elevated liver enzymes in target groups, such as obese persons, patients with type 2 diabetes mellitus, the level of suspicion should be raised for the frequent diagnosis of NASH.1 Case Report A 32 years old obese man presented to our institution with persistently elevated ALT and AST for two years. He was diagnosed as a case of chronic hepatitis caused by HBV infection and was treated with Lamivudine for two years. Though his HBV DNA load became negative, serum ALT and AST did not normalize. Review of systems raveled no significant symptoms and there was no significant past medical history and family history regarding the illness. On examination his BMI was 29.8 Kg/m2 and there is no other abnormality. On investigation, Complete J MEDICINE 2010; 11 : 90-93