The patient was a 26-year-old man who had been diagnosed with gout at the age of 24 years and had recurrent episodes of arthritis at the age of 26 years. The patient first consulted the Teikyo University Hospital in June 2002. He did not drink alcohol. Obesity (BMI: 27.2), hyperuricemia, and hepatic dysfunction(ALT: 123IU/l, and γ-GTP: 62IU/l)were confirmed, and abdominal ultrasound confirmed severe fatty liver. After five months of an 1800kcal/day diet, the patient's BMI had dropped to 24.6, and liver dysfunction had improved (ALT: 21IU/l), though hyperuricemia persisted (8.6-9.5 mg/dl). Benzbromarone (25 mg/day) was initiated in March 2003. However, after three months, ALT increased to 60 IU/l and thereafter increased rapidly to 120 and 210IU/l. Benzbromarone was therefore discontinued after six months; however, liver dysfunction did not improve, and the level of ALT increased to 581 IU/l two months after the end of therapy. Liver biopsy showed moderate-to-large fatty deposits in the parenchyma, edematous changes of hepatocytes, centrilobular fibrosis, and fibrosis accompanying focal necrosis of the portal region, confirming nonalcoholic steatohepatitis (NASH). The patient was instructed to refrain from eating large quantities of snacks and junk food. BMI decreased to 23.1 and liver function normalized.
Since hyperuricemia did not improve even though BMI normalized, allopurinol was started. To the best of our knowledge, no previous reports have documented gout coexisting with NASH, and the present patient could therefore provide valuable information.