Fatty liver in adult coeliac disease

History and admission findings: A 31-year-old woman was admitted because of heptomegaly and abnormal liver functions. For years she had suffered from diarrhoea but its cause had never been elucidated. She was underweight and had mild ankle edema. The liver margin was palpable at 20 cm below the midc ostal margin, but the abdominal examination was otherwise unremarkable. Investigations: Sonography revealed a very large fatty liver. Biopsy showed fatty infiltration of nearly all the hepatocytes, without significant infl ammation and fibrosis. Small-intestinal biopsy showed the typical histology of coeliac disease. Laboratory tests indicated abnormal liver function wit h increased transaminases, alkaline phosphatase, GPT and LDH, but no sign o f inflammatory aetiology. These findings suggested that the liver changes w ere due to the coeliac disease. Treatment and course: After the patient had been put on a gluten-free diet the diarrhoea stopped a nd she started to gain weight. The liver function t ests briefly became worse, but over the following 6 weeks normalized comple tely. The patient gained 5 kg in the subsequent 18 months and the liver bec ame sonographically normal. The small-intestinal biopsy now showed merely d iscrete villar atrophy. Conclusion: Coeliac disease should be considered in any case of fatty liver of unknown cause. Strict gluten-free dietary treatment of the underlying c ause can quickly lead to complete regression of the hepatic changes.