Werner syndrome as a possible cause of nonalcoholic steatohepatitis

Abstract

Nonalcoholic steatohepatitis (NASH) is characterized by steatosis, liver cell injuries, the presence of a mixed inflammatory lobular infiltrate, and variable degrees of fibrosis. Werner syndrome (WS) is a rare autosomal recessive disease characterized by the premature onset of multiple age-related disorders. Central obesity and insulin resistance are common symptoms of both NASH and WS. We therefore studied three cases to evaluate the association between WS with NASH. NASH was diagnosed by liver biopsies and imaging studies following the exclusion of alcohol consumption, viral, or autoimmune liver disease. Liver histology was compatible with NASH in all cases. Liver dysfunction, hyperlipidemia, insulin resistance and regional increase of intra-abdominal fat even though the body mass indices were all normal or low, were observed. Metabolic disorders due to WS may complicate and cause NASH. Hence, the observed clinical association between WS and NASH suggests that patients with WS should also be screened for NASH.