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Acute liver injury in a non-alcoholic fatty liver disease patient with chloroform exposure: a case report

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Abstract

We report a rare case of acute liver injury by daily exposure to small amounts of chloroform in non-alcoholic fatty liver disease (NAFLD) patient. The patient had been followed up in our hospital every 3 months. Although his alanine aminotransferase (ALT) levels were steady around 30 ~ 60 U/L until August 2014, ALT level was spontaneously increased to more than 1,000 U/L at the follow-up point in late August 2014. As he was diagnosed as acute liver injury by chloroform exposure, we withdrew him from the exposure of chloroform and treated him with 600 mg/day of ursodeoxycholic acid. Afterwards, his ALT level rapidly improved and normalized within 1 month. To verify the influences of chloroform exposure, we measured plasma chloroform levels by gas chromatography. Although plasma chloroform concentration was 7.1 ng/ml (normal range: < 0.2 ng/ml) at the time of liver injury, the concentration had decreased to 0.7 ng/ml by 1 month later. Despite the fact that he had put on a face mask to protect from aspiration of chloroform, liver injury still occurred in the present case. Chloroform has a high solubility for lipids and accumulation of lipids in the liver might become a risk factor for liver injury by chloroform.

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Abbreviations

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

UDCA:

Ursodeoxycholic acid

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Acknowledgements

The authors thank prof. Akira Namera (Department of Forensic Medicine, Hiroshima university) for excellent technical advice, Kenji Yamamuro and Kimiaki Sumino (Osaka Occupational Health Service Center, Japan Industrial Safety and Health Association) for the measurement of serum chloroform concentration, and Dr. Grace Naswa Makokha for the proofreading of the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan

    Yosuke Suehiro, Takuro Uchida, Masataka Tsuge, Eisuke Murakami, Daiki Miki, Tomokazu Kawaoka, Michio Imamura, Hiroshi Aikata & Shiro Oka

  2. Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan

    Masataka Tsuge

  3. Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan

    Koji Arihiro

Authors
  1. Yosuke Suehiro
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  2. Takuro Uchida
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  3. Masataka Tsuge
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  4. Eisuke Murakami
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  5. Daiki Miki
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  8. Hiroshi Aikata
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  9. Koji Arihiro
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  10. Shiro Oka
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Correspondence to Masataka Tsuge.

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Suehiro, Y., Uchida, T., Tsuge, M. et al. Acute liver injury in a non-alcoholic fatty liver disease patient with chloroform exposure: a case report. Clin J Gastroenterol 16, 250–253 (2023). https://doi.org/10.1007/s12328-023-01760-7

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  • DOI: https://doi.org/10.1007/s12328-023-01760-7

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