An underrecognized cause of hepatomegaly in uncontrolled type I diabetes.

A 29-year-old woman with a past medical history of poorly controlled type 1 diabetes and autoimmune hypothyroidism presented to the emergency department for evaluation of abdominal pain, nausea and vomiting. The patient was a cocaine user, but she did not use alcohol and did not smoke. Her current medications included Insulin aspart, Insulin degludec, L-thyroxine and Pantoprazole. She reported no use of over-thecounter medication or herbal and dietary supplements. acute distress. The abdomen was nondistended and soft with diffusely tenderness and a smooth palpable liver 3 to 4 cm below the costal margin. Laboratory studies was significant for glucose 539 mg/dL (normal 65-110), alkaline phosphatase 153 U/L (normal 35-105), gamma-GT 44 U/L (normal <36), lactate 42,1 mg/dL (normal 4,5-19,8), arterial pH 7,32 (normal 7,35-7,45) and HbA1c 11% (4,5-6). A computed tomography (figure 1; panel A and B) and liver biopsy (figure 1; panel C and D) were performed.