Cyanamide-induced liver dysfunction after abstinence in alcoholics: A long-term follow-up study on four cases

Background: Cyanamide, an aversive agent widely used in Japan, is known to induce various degrees of hepatic lesion with ground-glass inclusion bodies . When cyanamide-treated alcoholics relapse into drinking, more severe infl ammation develops in the liver. However, it is controversial whether progre ssive hepatic lesions develop in complete abstainers as a result of long-te rm cyanamide treatment. Case Reports: Case 1: A 53-year-old male alcoholic received cyanamide treat ment for 4.5 months and completely abstained without cyanamide treatment fo r 6 years. A liver biopsy shortly after abstinence showed extensive pericel lular fibrosis, but a biopsy after 6 years showed very mild fibrosis. Case 2: A 43-year-old male alcoholic remained completely abstinent with cyanamid e treatment for 5 years and complained of general fatigue. His serum transa minases were slightly elevated and hepatic hyperechogenicity was observed o n ultrasonography. Only mild pericellular fibrosis was present in the liver biopsy specimen obtained shortly after abstinence, but after 5 years the s econd liver biopsy showed that thin septum-like fibrosis that formed portal -to-portal and portal-to-central linkage had developed and ground-glass hep atocytes had emerged extensively. Case 3: A 29-year-old female alcoholic co mplained of general fatigue and a slight fever after 1.5 years of abstinenc e with cyanamide treatment. Slight elevation of serum transaminases and hep atic hyperechogenicity were observed. The liver biopsy showed extensive gro und-glass hepatocytes and thin septum-like fibrosis that formed portal-to-p ortal linkage. Case 4: A 61-year-old male alcoholic who remained completely abstinent while taking cyanamide for 3 years showed slight elevation of se rum transaminases. Liver biopsy showed extensive ground-glass hepatocytes a nd extension of thin septum-like fibers from portal tract to the lobule. Ul trasonography revealed hepatic hyperechogenicity. Conclusion: In some abstainers who take cyanamide for several years, thin s eptum-like liver fibrosis progresses along with the emergence of ground-gla ss hepatocytes. Hepatic hyperechogenicity on ultrasonography and slight ele vation of serum transaminases might erroneously lead to a diagnosis of hepa tic steatosis without liver histology.