23rd August 2024

A 19-year-old caucasian man is referred to the acute assessment unit with abnormal liver function tests

A 19-year-old caucasian man is referred to the acute assessment unit with abnormal liver function tests. Over the last few months he has lost his appetite and has been increasingly tired. He denies abdominal pain or a change in bowel habit. He has no family history of liver disease. He has no recent foreign travel. He drinks 5-6 cans of beer per week.

His abdomen is soft, non tender and no palpable masses are felt. His chest is clear and his heart sounds are normal. He has yellow discoloration of his sclera but no skin changes and no tattoos. You note a slight tremor in his right hand but otherwise his neurology is normal.

Blood results are: Hb 150 (130-180 g/L), ferritin 200 ug/l (30 – 400 ug/L), caeruloplasmin 9 mg/dL (20 -35 mg/dL), alpha-1 antitrypsin 1.9 g/L (1.10-2.10 g/L), viral hepatitis screen negative, autoimmune liver screen negative, CRP 10 mg/L (<5 mg/L),  WCC 9.7 x 10(9)/L (2.9-9.6 x 10^9/L).

What is the most likely diagnosis?

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