[Hepatic overload of gangliosides after perhexiline maleate. Morphological and biochemical course (author's transl)]

A 72 years old man treated with perhexiline maleate (400 mg during 15 months) complained of skin rash, sensitive neuropathy, liver damage and mild renal insufficiency. Clinical status improved when the treatment was stopped, but liver size and renal status remained inchanged. Liver biopsy were performed at 0,6 and 15 months after the end of treatment. Inflammation and hepatocyte necrosis, seen on the first specimen, disappeared latter. Steatosis and voluminous, swollen, foamy liver seen were present in the three biopsies. Sclerosis had increased in the last one in spite of treatment arrest. Histochemical study exhibited liver storage of triglycerides, fatty acids, phospholipids, and gangliosides. Cytoplasmic glycogen was increased and some nuclei were glycogenated. Enzymatic pattern suggests a minor form of type I glycogen storage or increased neoglycogenesis. Perhexiline relation to this complex liver storage is discussed.