Decompensated cryptogenic liver cirrhosis: a case report and literature review

Liver cirrhosis is a pressing problem in clinical gastroenterology. It is characterized by a prolonged, asymptomatic course, frequent sudden decompensation, and high mortality. Objective. To present a clinical case of decompensated cryptogenic liver cirrhosis and to review current data on its possible causes, natural history, diagnosis, treatment, and outcomes. Materials and methods. A 42-year-old female patient underwent clinical, laboratory, and instrumental assessment, including abdominal ultrasonography, computed tomography, and oesophagogastroduodenoscopy; current Russian and international literature was also analysed. Results. The patient had ascites, portal hypertension, splenomegaly, hypersplenism, oesophageal varices, and grade II hepatic encephalopathy. Viral hepatitis, alcohol misuse, autoimmune liver disease, and hereditary liver disorders were excluded, which allowed the diagnosis of cryptogenic liver cirrhosis to be established. Conclusion. Cryptogenic liver cirrhosis is a diagnosis of exclusion and often represents the end stage of previously unrecognised metabolically associated steatotic liver disease. Early comprehensive diagnosis and timely correction of complications are crucial for prognosis.

1. Rinaldi L., Giordano M., Guerrera B., Amelia A., Fascione M. C., Zampino R., Nevola R., Iuliano N., Rosato V., Adinolfi L. E., Nascimbeni F., Masetti C., Romagnoli D., Baldelli E., Lonardo A., Ballestri S. Clinical features and natural history of cryptogenic cirrhosis compared with hepatitis C virus-related cirrhosis. World Journal of Gastroenterology. 2017; 23 (8): 1458–1468 (accessed: 03.05.2026).

2. Marmur J., Bergquist A., Stal P., Broome U. Liver transplantation of patients with cryptogenic cirrhosis: clinical characteristics and outcome. Scandinavian Journal of Gastroenterology. 2010; 45 (1): 60–69.

3. Ayata G., Gordon F. D., Lewis W. D., Pomfret E., Pomposelli J. J., Jenkins R. L., Khettry U. Cryptogenic cirrhosis: clinicopathologic findings at and after liver transplantation. Human Pathology. 2002; 33 (11): 1098–1104.

4. Nalbantoglu I., Jain D. Cryptogenic cirrhosis: old and new perspectives in the era of molecular and genomic medicine. Seminars in Diagnostic Pathology. 2019; 36 (6): 389–394. doi: 10.1053/j.semdp.2019.07.003 (accessed: 03.05.2026).

5. Al Ghamdi K., Bawareth R., Alqufayi A., Alshamase R., Algarni M., Alshehri A., Alshahrani N., Alatawi J., Allahiani W., Alhadlaq F., Alabdullatif G., Alharbi R. Clinical Characteristics, Evaluation, Treatment, and Prognosis of Cryptogenic Cirrhosis. Journal of Healthcare Sciences. 2022. doi: 10.52533/JOHS.2022.2907 (accessed: 03.05.2026).

6. Caldwell S. H., Oelsner D. H., Iezzoni J. C., Hespenheide E. E., Battle E. H., Driscoll C. J. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology. 1999; 29 (3): 664–669 (accessed: 03.05.2026).

7. Poonawala A., Nair S. P., Thuluvath P. J. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case-control study. Hepatology. 2000; 32 (4): 689–692.

8. Senanayake S. M., Niriella M. A., Weerasinghe S. K., Kasturiratne A., De Alwis J. P., De Silva A. P., Jayasinghe S., Nimralanathan N., Kumanan T., Dassanayake A. S., Ramanayake S. P., De Silva H. J., Kasturiratne A., Kiriella G. D. Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single centre retrospective study. BMC Research Notes. 2012; 5: 663. doi: 10.1186/1756-0500-5-663.

9. Giannini E. G., Marabotto E., Savarino V., Trevisani F., Di Nolfo M. A., Del Poggio P., Benvegnù L., Farinati F., Zoli M., Borzio F., Chiaramonte M., Caturelli E., Rapaccini G. L., Sacco R., Villa E., Foschi F. G., Gasbarrini A. Hepatocellular carcinoma in patients with cryptogenic cirrhosis. Clinical Gastroenterology and Hepatology. 2009; 7 (6): 580–585.

10. De Amico M., Pasta F., Pasta L. Thrombophilic genetic factors PAI-1, 4G-4G and MTHFR 677TT as risk factors of alcohol, cryptogenic liver cirrhosis and portal vein thrombosis in a Caucasian population. Gene. 2015; 568 (1): 85–88. doi: 10.1016/j.gene.2015.05.033.

11. Duclos-Vallée J. C., Yilmaz F., Johanet C., Roque-Afonso A. M., Gigou M., Trichet C., Dussaix E., Bismuth H., Samuel D. Could post-liver transplantation course be helpful for the diagnosis of so-called cryptogenic cirrhosis? Clinical Transplantation. 2005; 19 (5): 591–599.

12. Tardu A., Karagul S., Yagci M. A., Ertugrul I., Sumer D., Kirmizi S., Haberal M. Histopathological examination of explanted liver after transplantation in patients with cryptogenic cirrhosis. Transplantation Proceedings. 2015; 47 (5): 1450–1452.

13. Rinaldi L., Giordano M., Guerrera B., Amelia A., Fascione M. C., Zampino R., Nevola R., Iuliano N., Rosato V., Adinolfi L. E., Nascimbeni F., Masetti C., Romagnoli D., Baldelli E., Lonardo A., Ballestri S. Cryptogenic cirrhosis: current knowledge and future directions. World Journal of Gastroenterology. 2016. URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC6490261/ (accessed: 03.05.2026).

14. O'Leary J. G., Landaverde C., Jennings L. F., Goldstein R. M., Davis G. L. Patients with NASH and cryptogenic cirrhosis are less likely than those with hepatitis C to receive liver transplants. Clinical Gastroenterology and Hepatology. 2011; 9 (9): 700–704.e1. doi: 10.1016/j.cgh.2011.04.007 (accessed: 03.05.2026).

15. Charlton M. R., Kondo M., Robert S. K., Steers J. L., Krom R. A., Wiesner R. H. Liver transplantation for cryptogenic cirrhosis. Liver Transplantation and Surgery. 1997; 3 (4): 359–364.

16. Huang D. Q., Terrault N. A., Tacke F., Gluud L. L., Arrese M., Bugianesi E., Kao J. H., Janssen H. L. A., Sarin S. K., Patel K., Younossi Z. M., Petrick J. L., Rashid R., El-Serag H. B., Barritt A. S. IV, Wong V. W.-S., Foster G. R., Kim Y. J., Esmat G., Wong R. J., Thu H. A., Siddiqui M. S., Sheikh M. Y., Thuluvath P. J., Khakhar A. K., Chong V. H., Castera L., Nguyen M. H., Lim S. G., Ioannou G. N., Zeldis J. B., Yang H.-I., Chuang C.-H., Wu C.-Y., Lee M.-H., Su C.-W., Huo T.-I., Salame F., Francque S., Romero-Gómez M., Abraldes J. G., Jalan R. J., Moreau R., Arroyo V., Strnad P., Cortez-Pinto H., Bowlus C. L., Ha Q. H., Fiel M. I., Szabo G. Global epidemiology of cirrhosis – aetiology, trends and predictions. Nature Reviews Gastroenterology & Hepatology. 2023; 20 (12): 765–792. doi: 10.1038/s41575-023-00846-4 (accessed: 03.05.2026).

17. Sanjeevi A., Lyden E., Sunderman B., Weseman R., Ashwathnarayan R., Mukherjee S., Shaw B. W. Jr. Outcomes of liver transplantation for cryptogenic cirrhosis: a single-centre study of 71 patients. Transplantation Proceedings. 2003; 35 (8): 2977–2980.

18. Álamo J. M., Bernal C., Barrera L., Marín L. M., Suárez G., Serrano J., Gómez M., Pascasio J. M., Briceno J., De la Mata M. Liver transplantation in patients with cryptogenic cirrhosis: long-term follow-up. Transplantation Proceedings. 2011; 43 (6): 2230–2232.

19. El Atrache M. M., Abouljoud M. S., Divine G., Yoshida A., Kim D. Y., Kazimi M. M., Sontag M., Moonka D., Dyer J., Wright H. Recurrence of non-alcoholic steatohepatitis and cryptogenic cirrhosis following orthotopic liver transplantation in the context of the metabolic syndrome. Clinical Transplantation. 2012; 26: E505–E512.

20. Sharma B., John S. Hepatic cirrhosis. StatPearls. – Treasure Island (FL): StatPearls Publishing, 2022. NCBI Bookshelf. 2022. URL: https://www.ncbi.nlm.nih.gov/books/NBK541132/ (accessed: 03.05.2026).