CASE REPORT: Alcoholic Foamy Degeneration and a Markedly Elevated GGT: A Case Report and Literature Review

Alcoholic liver disease covers a spectrum of pathologic appearance ranging from fatty liver disease to acute sclerosing hyaline necrosis (ASHN) to cirrhosis (1). In 1983, Uchida et al described a group of 21 patients with a history of chronic alcohol ingestion who presented with a distinct liver pathology termed alcoholic foamy degeneration (AFD) (2). AFD is a noninflammatory condition seen in chronic alcoholics that was originally reported to be associated with acute hepatic decompensation and is characterized by microvesicular fatty accumulation often with a centrilobular accentuation similar to that seen in Reye’s syndrome, tetracycline toxicity, and acute fatty liver of pregnancy (2). It does not seem to be associated with a progression of hepatic fibrosis (3). In another report of 389 consecutive chronic alcoholic subjects who underwent liver biopsies, 9 patients were identified to have histological evidence of AFD (4). In this series, hepatic decompensation was not present in all of the 9 patients identified to have AFD (4). Patients in both these series showed higher serum levels of aminotransferases and serum γ -glutamyltranspeptidase (GGT) than seen in ASHN, more in keeping with acute hepatic inflammation. However, patients may be asymptomatic and only have mild biochemical abnormalities (4). On the other hand, the liver histology in these patients, unlike ASHN, was more consistent with a degenerative process with minimal or no inflammation.