18th July 2023

A 67-year-old man comes to see you in a general medical clinic. He presents with a 6-month history of epigastric pain

A 67-year-old man comes to see you in a general medical clinic. He presents with a 6-month history of epigastric pain, nausea, fatigue and swelling of his legs. He has no past medical history of note and is normally fit and well. On examination, you note bilateral pitting oedema to the mid-shins. The patient’s weight is 75kg and he reports that this has been stable.

You order some investigations for this patient. An ECG is normal. Echocardiography revealed an ejection fraction of 65%, normal appearance of the left and right ventricles with a normal estimated pulmonary artery systolic pressure. Transient elastography of the liver reveals a fibrosis score of F0 (no fibrosis). He undergoes upper GI endoscopy, which shows giant mucosal folds in the gastric fundus and body.

His blood results are as follows:

Which of the following is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.