Ota Soichiro, Hamada Michika, Muramatsu Ken-Ichi, Takeuchi Ikuto, Yanagawa Youichi
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan.
Case Rep Gastroenterol. 2022 Sep 19;16(3):557-562. doi: 10.1159/000526570. eCollection 2022 Sep-Dec.
A 74-year-old man, who lived alone, was found in an unconscious state in his house by a neighbor after mail accumulated in his mailbox. He had asthma and nephrotic syndrome, which had been treated by prednisolone (10 mg) for more than 10 years, and steroid-induced DM. He had been obese since his 20s and had never drunk or smoked in his life. On arrival, he was obese and in a coma and shock state with respiratory failure. He therefore underwent rapid fluid resuscitation, tracheal intubation, mechanical ventilation, with cardiopressor treatment. Whole body computed tomography revealed atrophic liver and excess visceral fat. The clinical diagnosis was septic shock, acute respiratory failure, renal failure with hyperkalemia, cerebral ischemia, liver cirrhosis, rhabdomyolysis, DM, and upper gastrointestinal bleeding. On day 3, his circulation, respiratory function, and consciousness stabilized, and he was extubated. Further studies led to a diagnosis of burn-out nonalcoholic steatohepatitis (NASH). His condition was complicated by adrenal insufficiency, pulmonary embolism, lower extremity motor weakness, and left leg phlegmon during hospitalization. He was transferred to another hospital for rehabilitation on day 34 after the improvement of phlegmon. The present case showed the potential for NASH to develop in individuals with long-term steroid use. The further accumulation and analysis of cases is required to determine whether this possibility is correct or not.
一名74岁独居男性，因邮箱里积攒了邮件，被邻居发现在家中处于昏迷状态。他患有哮喘和肾病综合征，使用泼尼松龙（10毫克）治疗超过10年，还有类固醇诱导的糖尿病。他从20多岁起就肥胖，一生从未饮酒或吸烟。入院时，他肥胖，处于昏迷和休克状态，伴有呼吸衰竭。因此，他接受了快速液体复苏、气管插管、机械通气及强心治疗。全身计算机断层扫描显示肝脏萎缩和内脏脂肪过多。临床诊断为感染性休克、急性呼吸衰竭、肾衰竭伴高钾血症、脑缺血、肝硬化、横纹肌溶解、糖尿病和上消化道出血。第3天，他的循环、呼吸功能和意识稳定，拔除了气管插管。进一步检查诊断为耗竭性非酒精性脂肪性肝炎（NASH）。住院期间，他的病情并发肾上腺功能不全、肺栓塞、下肢运动无力和左腿蜂窝织炎。蜂窝织炎好转后，他于第34天转至另一家医院进行康复治疗。本病例显示长期使用类固醇的个体有发生NASH的可能性。需要进一步积累和分析病例，以确定这种可能性是否正确。
