Diet-refractory NASH in an elderly woman

Here we report a case of a 68-year-old woman who presented to our centre for further evaluation of elevated liver function tests (LFTs). She reported a 20-year history of elevated liver enzymes. She had known dyslipidaemia (low-density lipoproteincholesterol of 232 mg/dL) and was treated with atorvastatin and ezetimibe. Diabetes and cardiovascular events were not reported. Family history was suspected as a factor as her father died due to heart attack and also had a history of elevated LFTs; her brother died due to cryptic cirrhosis. The patient underwent multiple liver biopsies in several liver centres (1996, 1999, 2003 and 2008). Histology results similarly demonstrated microvesicular fatty liver with minimal fibrosis. In line with the patient’s metabolic profile, her case was treated as non-alcoholic steatohepatitis (NASH)-related although histological …