Complicated Treatment Course of Severe Asymptomatic Hypertriglyceridemia: A Case Report and Literature Review

Area of Science:

• Cardiology
• Hepatology
• Endocrinology

Background:

• Severe hypertriglyceridemia (HTG) is often managed with lifestyle changes, statins, and fibrates.
• Concurrent use of statins and fibrates poses a risk of medication-induced liver injury.
• Asymptomatic severe HTG requires careful management to prevent complications.

Approach:

• A case report of a 43-year-old male with severe HTG (>11,370 mg/dL) initially treated with high-intensity statins and fibrates.
• The patient developed acute liver injury due to the combined medication, necessitating cessation of oral drugs and hospital admission.
• Treatment involved an insulin drip, initially resistant, requiring dose escalation, followed by discharge on fenofibrate and subcutaneous insulin.

Key Points:

• Concurrent statin-fibrate therapy led to acute liver injury in a patient with severe asymptomatic HTG.
• Triglyceride levels were resistant to standard insulin therapy, requiring higher doses.
• Management shifted to fenofibrate and insulin, with subsequent discontinuation of fibrate and reliance on statins and lifestyle modifications.

Conclusions:

• This case underscores the importance of heightened awareness and collaborative efforts in managing severe asymptomatic HTG, especially when liver injury occurs.
• Further research is needed on managing severe asymptomatic HTG in patients experiencing liver injury.
• This report contributes valuable insights into the complex management of rare HTG cases complicated by acute liver injury.