Diabetic hepatosclerosis presenting with severe cholestasis

Diabetic hepatosclerosis (DH) is a novel entity that has recently been characterized by reviewing archived liver biopsies (1–3). Little is known about its clinical presentation. A 37-year-old man was admitted to our hospital for nephrotic syndrome and a trophic ulcer in the left leg. He had been diagnosed with diabetes 12 years before and treated with insulin ever since. He had nephropathy, neuropathy, retinopathy, and arterial hypertension. Early during hospitalization, sepsis secondary to infection of the leg ulcer and renal failure cooccurred, reciprocally exacerbating one another. The situation rapidly deteriorated despite antibiotic and supportive therapy, requiring hemodialysis first and then amputation of the infected limb. Histological examination revealed dense perisinusoidal fibrosis and concentric hyaline thickening of the hepatic arterioles. Signs of ductal injury were also noted. There was no steatosis, necroinflammatory activity, granulomatous infiltration, or copper-associated protein deposition. Although rare, DH should be taken into account in the differential diagnosis of cholestasis in diabetes.