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Finally, the gut microbiome may contribute to NAFLD pathogenesis: an increased intestinal permeability could lead to the entry of endotoxins in portal circulation and activation, through toll-like receptor 4, of Kupffer cells, with consequent inflammation (5053)
On examination, there was diffuse hyperpigmentation predominantly seen over the face, bilateral forearms, lower legs, palms and soles [Figure 1]
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