Author Affiliations: Departments of Medicine (Drs Clark and Diehl) and Epidemiology (Dr Clark), Johns Hopkins University, Baltimore, Md.
Grand Rounds at The Johns Hopkins Bayview Medical
Center Section Editors: David B. Hellmann, MD, Charles Weiner, MD,
Stephen D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S.
Cooper, MD, Contributing Editor, JAMA.
Cryptogenic cirrhosis is a common cause of liver-related morbidity and
mortality in the United States. Nonalcoholic fatty liver disease (NAFLD) is
now recognized as the most common cause of cryptogenic cirrhosis. However,
the diagnosis of cirrhosis in patients with NAFLD appears to be delayed compared
with those with other chronic liver diseases and thus carries a higher mortality
rate. This delay in diagnosis is illustrated in our case of a 53-year-old
man who presented with hepatic hydrothorax and ascites, whose workup revealed
cirrhosis due to NAFLD. Although a diagnosis of presumed NAFLD can be made
noninvasively, a definitive diagnosis requires a liver biopsy specimen. A
biopsy specimen is also important for detecting histologically advanced disease,
which may be clinically silent and undetected by aminotransferases or diagnostic
imaging. Although there are no proven treatments, recommendations for patients
with NAFLD include avoidance of hepatotoxins and aggressive management of
associated conditions, such as hypertriglyceridemia and type 2 diabetes mellitus.
Clark JM, Diehl AM. Nonalcoholic Fatty Liver DiseaseAn Underrecognized Cause of Cryptogenic Cirrhosis. JAMA. 2003;289(22):3000-3004. doi:10.1001/jama.289.22.3000