A Chronic Case of Hepatosplenomegaly in Elderly Diabetic Male

This case report presents the case of a 65 year-old male with a longstanding history of type 1 diabetes of 45 years duration. His diabetes was poorly controlled, as evidenced by the development of complications including hepatosplenomegaly and anemia. The patient presented with constitutional symptoms of fatigue, abdominal fullness and early satiety. His laboratory investigations revealed anemia with a hemoglobin of 11.5 gm% and a reduced red blood cell count. Ultrasonography showed hepatosplenomegaly with minimal ascites. A wide differential diagnosis for hepatosplenomegaly was considered, including infectious, hematological and autoimmune causes. However, in this patient with longstanding diabetes, the most likely etiology was diabetic microangiopathy leading to portal hypertension and congestion of the liver and spleen. Thorough diagnostic workup was performed to rule out other potential causes of hepatosplenomegaly. The management approach focused on improving glucose control to slow the progression of microvascular complications. Optimization of medications and lifestyle modifications were initiated. Monitoring for complications of portal hypertension such as variceal bleeding and ascites was instituted.