Dubin-Johnson-like black liver with normal bilirubin level

J Gastroenterol. 2004 Sep;39(9):892-5. doi: 10.1007/s00535-004-1406-x.

Abstract

Black liver is a common finding in Dubin-Johnson syndrome (DJS), which is caused by the lack of multidrug resistance-associated protein 2 (MRP2). Impaired excretion of epinephrine metabolites is believed to be a cause of black liver in DJS. Recently, we experienced a patient with black liver whose serum bilirubin level was normal. Coarse brown granules were observed in the hepatocytes, and this finding closely resembled that observed in DJS. However, the granules were negative for Schmorl staining. The MRP2 gene did not show any mutation. Immunostaining study demonstrated MRP2 protein expression in the liver, and it was localized in the canalicular membranes of hepatocytes. This case illustrates for the first time that DJS is not the only cause of black liver.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Bilirubin / blood*
  • Blood Chemical Analysis
  • Color
  • DNA Mutational Analysis
  • Hepatocytes / metabolism*
  • Humans
  • Immunohistochemistry
  • Jaundice, Chronic Idiopathic / blood*
  • Jaundice, Chronic Idiopathic / genetics
  • Liver / metabolism
  • Male
  • Membrane Transport Proteins / genetics
  • Membrane Transport Proteins / metabolism*
  • Multidrug Resistance-Associated Protein 2
  • Multidrug Resistance-Associated Proteins / genetics
  • Multidrug Resistance-Associated Proteins / metabolism*
  • Silver Nitrate

Substances

  • ABCC2 protein, human
  • Fontana-Masson stain
  • Membrane Transport Proteins
  • Multidrug Resistance-Associated Protein 2
  • Multidrug Resistance-Associated Proteins
  • Silver Nitrate
  • Bilirubin