Purpose or Case Report: Several possible etiologies for focal hepatic steatosis have been explored to date, and in this case of a 14 year old female patient, the hepatotoxic side effect of Gabapentin was clinically addressed as a possible, very rare culprit. There is extremely limited data on the hepatotoxic effects of gabapentin and only a few individual case reports of liver injury from gabapentin have ever been published. The patient was started on Gabapentin by her ENT physician for ear pain approximately three months prior to her imaging workup. Since starting the medication, she had developed symptoms of nausea, vomiting, and right upper quadrant abdominal pain. Her physician referred her for radiologic evaluation of her abdominal symptoms.
Methods & Materials: The patient’s imaging workup was initially performed with sonographic evaluation of the right upper quadrant of the abdomen. A same day HIDA scan was performed immediately following the ultrasound. An MRI of the abdomen with contrast the following day was obtained on a 1.5T Siemens scanner.
Results: The ultrasound demonstrated a normal gallbladder and three hyperechoic solid lesions within the left liver measuring up to 3.8 cm. The liver itself was normal in size and noncirrhotic in appearance. The HIDA nuclear medicine scan was normal. The MRI demonstrated intralesional fat characteristics of mildly increased precontrast T1 signal and signal dropout on the out of phase images within all three of the hepatic lesions. There was no enhancement or other suspicious features, and traversing, nondisplaced portal and hepatic veins were visualized through these lesions. The patient had been taking 100mg Gabapentin 1-2 capsules PO TID, and following review of clinical symptoms and imaging findings by her pediatric GI and behavioral specialist physicians, she began tapering off the medication completely.
Conclusions: Focal hepatic steatosis may appear as multiple nodular areas in atypical locations producing a pseudotumor appearance and can pose a diagnostic challenge, especially with more atypical presentations as seen in this patient. Although not as common as the diffuse form, the focal form has a significant prevalence in the pediatric population and the natural history and possible etiologies are not yet fully understood. Additionally, this case demonstrates how the judicial use of MRI may help clarify challenging pediatric patient cases in a manner that upholds the principles of ALARA.