Transaminases in the Thousands: Glycogenic Hepatopathy Mimicking Acute Hepatitis.

Glycogenic hepatopathy (GH) is an uncommon condition that can develop in people with poorly controlled diabetes, as a result of excessive intrahepatic glycogen accumulation. It often presents with asymptomatic elevations in liver enzymes (around 250-750 IU/L), frequently misdiagnosed with other liver diseases. We report a 17-year-old boy with type-1-diabetes presenting with abdominal discomfort and severely elevated transaminases (>1000 IU/L). Extensive evaluation excluded viral, autoimmune, metabolic, and drug-related causes. Imaging demonstrated hepatomegaly, and liver biopsy confirmed GH with Periodic acid-Schiff (PAS)-positive diastase-sensitive glycogen accumulation. Optimization of insulin therapy led to rapid normalization of liver enzymes. This case highlights the importance of considering glycogenic hepatopathy in diabetic patients with severely elevated transaminases.