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Jin, Song, Cho, Shin, Shin, Kim, Park, and Rim: A Case of Nodular Regenerative Hyperplasia of the Liver Combined with Toxic Hepatitis
Case Report

Korean J Gastroenterol 2015;65(1):52-56.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.1.52

A Case of Nodular Regenerative Hyperplasia of the Liver Combined with Toxic Hepatitis

Sun Mi Jin, Sang Hee Song, Yang Hyun Cho, Dae Kyu Shin, Sun Young Shin, Gwang Il Kim1, Hana Park, Kyu Sung Rim

Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea

1Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Correspondence to: Kyu Sung Rim, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea. Tel: +82-31-780-5212, Fax: +82-31-780-5219, E-mail: ksrimmd@cha.ac.kr

Received 7 July 20144 August 2014       Accepted 8 August 2014

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.

Keywords: Nodular regenerative hyperplasia, Drug-induced liver injury, Liver diseases

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Fig. 1.
Abdominal CT shows uneven hepatic nodular lesions with decreased enhancement at portal phase (A) and moderate amount of ascites at pre-contrast phase (B).
kjg-65-52f1.tif
Fig. 2.
Initial liver MRI shows large T2 low (A) and T1 high (B) nodular lesions in the liver.
kjg-65-52f2.tif
Fig. 3.
(A) Most hepatocytes are arranged in two-to-three cell thick plates, and small cell or large cell changes (arrowheads) are seen (H&E, ×100).(B) Masson trichrome stain (×40) shows absence of fibrosis and presence of portal tracts (arrows).
kjg-65-52f3.tif
Fig. 4.
Follow-up liver MRI shows progression of nodular regenerative hyperplasia in the liver. These nodular lesions show T2 low (A) and T1 high (B) signal intensity.
kjg-65-52f4.tif
Table 1.
Roussel Uclaf Causality Assessment Method Scale Score of Our Patient
Cholestatic type Score
1. Time to onset  
  From the beginning of the drug 5–90 days +2
  From cessation of the drug ≤30 days +1
2. Course  
  Decrease ≥50% within 180 days +2
3. Risk factors  
  No alcohol or pregnancy 0
  Age of the patient <55 years 0
4. Concomitant drug  
  None or no information or concomitant drug with incompatible time to onset 0
5. Exclusion of other causes of liver injury  
  HAV, HBV, HCV, biliary obstruction, alcoholism, recent hypotension +1
6. Previous information on hepatotoxicity of the drug  
  Reaction published but unlabeled +1
7. Response to readministration  
  Not done 0
Probable Total +7

The type of liver injury was considered as ‘cholestatic’ since R ratio (serum activity of ALT/serum activity of ALP) was 0.4.

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