Quick Case: Black Cirrhosis in a Khaini Abuser

A 64-year-old female presented with ascites, loss of weight, loss of appetite and severe weakness for the last 3 years. Upper and lower GI endoscopic findings were within normal limits. Macrocytic hypochromic anemia, elevated ESR, massive hepatomegaly and moderate spenomegaly were found, but no lymphadenopathy or any adnexal SOL. All liver enzymes were slightly elevated. No jaundice was found, nor any history of hepatitis. INR was 2.1. Serum was negative for screening for Hepatitis B and C. Ultrasound and CT-scan of the abdomen revealed nodular hepatomegaly with mild spenomegaly. Core biopsy from the liver nodules yielded charcoal-coloured, black, firm cores. Microscopy revealed macronodular cirrhosis due to nodular architecture of liver parenchyma as a result of porto-central fibrosis in a background of macrovesicular steatosis. Extensive sinusoidal deposition of black pigment was noted, adding to liver size. No malignancy was detected.

The patient died 5 months after diagnosis, due to hepatorenal failure.

Learning Points/Take Home Messages

Khaini-abusers may also suffer from peculiar pigmented or black cirrhosis, aside from upper aero-digestive tract carcinomas.