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Journal of Gastroenterology

, Volume 39, Issue 9, pp 892–895 | Cite as

Dubin-Johnson-like black liver with normal bilirubin level

  • Yoshinao Kobayashi
  • Tomoaki Ishihara
  • Morimasa Wada
  • Susumu Kajihara
  • Jun Araki
  • Rumi Mifuji
  • Toshio Itani
  • Makoto Kuroda
  • Fumihito Urawa
  • Masahiko Kaito
  • Yukihiko Adachi
Case report

Abstract

Black liver is a common finding in Dubin-Johnson syndrome (DJS), which is caused by the lack of multidrug resistance-associated protein 2 (MRP2). Impaired excretion of epinephrine metabolites is believed to be a cause of black liver in DJS. Recently, we experienced a patient with black liver whose serum bilirubin level was normal. Coarse brown granules were observed in the hepatocytes, and this finding closely resembled that observed in DJS. However, the granules were negative for Schmorl staining. The MRP2 gene did not show any mutation. Immunostaining study demonstrated MRP2 protein expression in the liver, and it was localized in the canalicular membranes of hepatocytes. This case illustrates for the first time that DJS is not the only cause of black liver.

Key words

black liver Dubin-Johnson syndrome multidrug resistance-associated protein 2 bilirubin 

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Copyright information

© Springer-Verlag Tokyo 2004

Authors and Affiliations

  • Yoshinao Kobayashi
    • 1
  • Tomoaki Ishihara
    • 1
  • Morimasa Wada
    • 2
  • Susumu Kajihara
    • 3
  • Jun Araki
    • 1
  • Rumi Mifuji
    • 1
  • Toshio Itani
    • 1
  • Makoto Kuroda
    • 1
  • Fumihito Urawa
    • 1
  • Masahiko Kaito
    • 1
  • Yukihiko Adachi
    • 1
  1. 1.Third Department of Internal Medicine, Division of Gastroenterology and HepatologyMie University School of MedicineTsuJapan
  2. 2.Department of Medical Biochemistry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.Department of Internal MedicineSaga University School of MedicineSagaJapan

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