The case of a 58-year-old female patient with no medical history is described. Her chief complains were aching pain in the upper right side of the abdomen, severe tiredness, and weakness. She had not presented any diseases, accident, falling down, or conditions related to her complains.
Upon her admission, the following vital signs were observed: body temperature 36.5°C, blood pressure 115/75 mmHg, heart rate 70 per minute, respiratory rate 13 per minute, and oxygen saturation 98%. And also, her body mass index (BMI) was 24.44. All other examination were normal. A blood tests to check her organs and an abdominal ultrasonography were ordered. Blood tests included white blood cell count, red blood cell count, hemoglobin, platelet, fasting blood sugar, hemoglobin A1c, triglyceride, cholesterol, calcium, phosphor, and vitamin D3 ranges were, in accordance with reference range, normal. However, the levels of AST and ALT were elevated, which accounted for 45 and 53 U/L, respectively; while the reference range for both of them were defined to be up to 40 U/L. Also, abdominal ultrasonography result is given in Fig. 1.
According to having increased levels of the liver enzymes ALT and AST in blood tests, and to abdominal ultrasonography result showing grade 2 of fatty liver, it was found that she has been afflicted with NAFLD. As of diagnosis, administration of silymarin 140 mg TID (with the brand name of Livergol from Goldaru Pharmaceutical Company, Iran) was initiated; taking silymarin had been continued for 30 days. Over the period, vital signs, in particular blood pressure, of patients were evaluated, and no unstable signs was observed. Also, no adverse effect – such as nausea, diarrhea, intestinal gas, fullness or pain in the stomach, and loss of appetite which was reported in some studies (20) – of taking silymarin was reported over the period of treatment.
After 30 days of taking silymarin 140 mg TID, lab tests were ordered. As a result, the levels of AST and ALT returned to their normal range, which accounted for 14 and 17 U/L, respectively. Patient also had no complains of pain in the upper right side of her abdomen and of feeling weakness.