Autopsy of a young alcohol abuser with severe fatty cirrhosis revealed potential interactions among alcohol-related disorders

We performed the autopsy of a man in his late twenties who was found dead in his house, Ihe man had abused alcohol for the last few years, and the autopsy revealed a yellowish and clearly enlarged liver. Histological examination revealed severe fatty cirrhosis with few normal hepatocytes. However, postmortem biochemical and serological examinations revealed elevated levels of hemoglobin Alc and ketone bodies, which indicated the previously unknown existence of diabetes mellitus (DM) and ketoacidosis. Liver cirrhosis, DM, and ketoacidosis influence each other and are all aggravated by alcohol abuse. As the ketoacidosis was thought to be caused by the DM (diabetic ketoacidosis), we suspected that these factors were involved in his death, despite the apparent fatty cirrhosis. However, the blood levels of ketone bodies were not high enough to cause his death, which is likely because the damaged liver became unable to produce ketone bodies (liver failure mitigated the ketoacidosis). therefore, we concluded that the cause of death was liver failure due to alcoholic fatty cirrhosis. Given the complicated interactions among alcohol-related disorders, postmortem histological, biochemical, and serological examinations are indispensable for clarifying the cause of death in similar cases.