Resolution of hepatic subcapsular steatosis after discontinuation of CAPD.

Fatty change of the liver is an extremely common lesion, generally found as a diffuse process involving the entire organ. Focal fatty infiltration appears to be rather rare and can be found in many different patterns [1]. Delivery of insulin in the peritoneal dialysate, instead of the usual subcutaneous route, is a wellestablished method for diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). It has been suggested that intraperitoneal insulin induces better metabolic control than subcutaneous insulin. However, this means of delivery can increase the risk of peritonitis, deteriorate serum cholesterol profile and expose the subcapsular hepatocytes to a higher concentration of insulin resulting in a unique pattern of subcapsular fatty infiltration [2,3]. Although presence of this unique fatty infiltration does not have any known clinical adverse effect, it is important to differentiate it from other low attenuated lesions including metastatic cancer, primary infiltrative neoplasms, hamartomatous lesions, haematomas and abscess of the liver [1]. The reversibility of fatty infiltration after caloric restriction in obese patients and alcohol withdrawn in patients with alcohol-induced fatty liver have been reported; however, no report exists demonstrating the complete resolution of subcapsular fatty infiltration in patients on CAPD. This report represents the case of a unique subcapsular steatosis induced with intraperitoneal insulin administration, that disappeared completely after discontinuation of peritoneal dialysis. Case report