P1396 - POSTER WITHDRAWN

Adrian Pona, MD¹, Caleb Rashidian, DO², Varun Moktan, MD¹, Pranav Patel, DO², Anjani Jammula, MD^3
1Prisma Health, University of South Carolina School of Medicine, Greenville, SC; ²Prisma Health Greenville Memorial Hospital, Greenville, SC; ³Prisma Health, Greenville, SC

Introduction: Von Meyenburg complexes (VMCs), or multiple biliary hamartomas, are rare and typically asymptomatic liver abnormalities, often discovered incidentally during laparotomies or imaging studies. Characterized by dilated, cystic biliary ducts, VMCs can mimic metastatic liver disease and other primary liver conditions, leading to extensive work-up and interventions.

Case Description/Methods: A 58 year-old female with a history of GERD, eosinophilic esophagitis, and Barrett's esophagus presented for routine labs with prior baseline ALP 152, AST 23, and ALT 26. Repeat labs reported ALP 155, AST 25, ALT 34, and GGT 139. Patient was also found to have mild hypercholesterolemia and started on a moderate-intensity statin. In the setting of mildly elevated LFTs an abdominal US was ordered and reported heterogeneous hepatic echotexture but no focal lesions. Patient was referred to GI for further investigations, including auto-immune and infectious disease work-up, which were unremarkable. A Fibroscan suggested early stage 3 fibrosis but no fatty liver disease. Labs repeated at 8 months demonstrated a peak with ALP 530, AST 67, and ALT 108. Subsequent liver biopsy revealed multiple VMCs without signs of cirrhosis or fibrosis, but with suggestion of impaired bile flow due to potential large duct obstruction. An MRI/MRCP later confirmed numerous T2 hyperintense lesions consistent with biliary hamartomas and no biliary duct obstruction. At this point, the patient’s statin was discontinued. Repeat labs within two weeks reported downtrending LFTs with ALP 302, AST 31, ALT 39 whereas repeat labs within 4 weeks reported continued decrease in ALP 211, AST 30, ALT 39.

Discussion: Incidentally found VMCs are managed with either serial observation for the risk of malignant transformation or confirmatory liver bx with surgical resection if the lesion is operable. Although usually asymptomatic, VMCs can present with elevation in AST/ALP/ALP. If a patient presents with elevated AST/ALT/ALP, serial lab trending is recommended to determine if such elevation is transient or persistent. The only treatment for patients with persistently elevated AST/ALT/ALP is liver transplantation. In this case a patient with new VMCs presented with significantly elevated LFTs after initiation of statin therapy in the setting of moderate alcohol use. Since abstaining from both, the patient’s LFTs were downtrending towards baseline. This case underscores the significance that VMCs, although benign, may increase risk of hepatic dysfunction.


Disclosures:


Adrian Pona, MD¹, Caleb Rashidian, DO², Varun Moktan, MD¹, Pranav Patel, DO², Anjani Jammula, MD³. P1396 - POSTER WITHDRAWN, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.