Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1475
Peer-review started: November 4, 2020
First decision: November 20, 2020
Revised: November 27, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: February 26, 2021
Congenital hepatic fibrosis (CHF) is a rare autosomal recessive disorder characterized by variable degrees of periportal fibrosis and malformation of bile ducts. CHF is generally accompanied by a variety of conditions or syndromes with other organ involvement.
We report a 5-year-4-month-old Chinese boy with congenital hypothyroidism (CH) diagnosed with CHF. The patient was diagnosed with CH by a newborn screening test and has since been taking levothyroxine. He has developed normally without neurocognitive deficits. Abnormal liver function was observed in the patient at the age of 4 years and 11 mo, and elevated levels of liver function indices were persistent for 5 mo. Radiological imaging indicated hepatospleno-megaly without narrowing of the portal vein but dilated splenic vein. A liver biopsy confirmed the pathological features of CHF. Genetic testing revealed two novel homozygous mutations, namely, c.2141-3T>C variant in PKHD1 related to CHF and c.2921G>A (p.R974H) in DUOX2 related to CH. The patient was treated with compound glycyrrhizin tablet, ursodeoxycholic acid, and levothyroxine after diagnosis. The patient achieved a favorable clinical outcome during a follow-up period of over 2 years.
Herein, we report the first case of a Chinese boy with comorbidity of CHF and CH, carrying both PKHD1 gene and DUOX2 gene novel mutations. Liver biopsy and genetic testing should be considered for the diagnosis of coexistent liver disease in CH patients with unexplained abnormal liver function.
Core Tip: Congenital hepatic fibrosis (CHF) is often accompanied by a variety of diseases, but this case introduces a rare comorbidity of CHF and congenital hypothyroidism (CH). Moreover, this report includes a detailed process of its diagnosis and treatment, which highlights that timely liver biopsy and genetic testing can be valuable tools for the diagnosis and differential diagnosis of CH coexistent with unexplained abnormal liver function.