A 57-year-old male of European ancestry with steatosis on ultrasound is referred to a tertiary center due to repeatedly elevated liver enzymes (last assessment: ALP 103 U/L (ULN: 130), AST 53 U/L (Lab ULN: 50), ALT 56 U/L (Lab ULN: 50), and GGT 75 U/L (ULN: 60)). The platelet count was 175 G/L, resulting in a FIB-4 of 2.31. The patient consumes 4 alcohol containing drinks/week and never smoked, is living with obesity with a BMI of 30.2 kg/m2, and has no other comorbidities/medications, unless COPD GOLD 2 group B which is treated by a long-acting β adrenoceptor agonist plus long-acting muscarinic receptor antagonist as a single inhaler. Anti HCV Ab, HBsAg, Anti HBsAb, Anti HBcAb, ANA, AMA, ASMA, and immunoglobulins were negative. The transferrin saturation was 56% with a serum ferritin of 561 μg/L. That patient’s liver stiffness measurement by vibration-controlled transient elastography at the tertiary center yields 9.1 kPa.
