A Polarizing Case of Elevated Liver Enzymes.

A 25-year-old male was referred to hepatology clinic for abnormal liver enzymes: AST 242 IU/L, ALT 507 IU/L, alkaline phosphatase 139 IU/L, INR 1.1, bilirubin 1.3 mg/dl, and albumin 4.2 g/dL. His hemoglobin was 13.3 g/dl and platelet count 130 x10(9) /L. The patient reported heavy alcohol use in teenage years but quit 1 year prior to presentation. Serologic testing was negative for viral hepatitis, autoimmune markers, Wilson disease, schistosomiasis, and alpha-1-antitrypsin deficiency. Transferrin saturation was 3%, ferritin 21 ng/ml, and 25-OH-vitamin D 14.1 ng/ml. A liver biopsy showed bilirubinostasis, portal inflammation, and bridging fibrosis.