A 35-year-old female of European descent is referred to a tertiary centre due to painless jaundice and elevated liver enzymes (ALP 167 U/L (ULN: 130), AST 876 U/L (ULN: 50), ALT 687 U/L (ULN: 50), and GGT 115 U/L (ULN: 60)). The serum bilirubin level is 9.5 mg/dL, albumin and INR are normal, the platelet count is 375 G/L. The patient consumes 2 drinks/week, is overweight (75 kg) with a BMI of 26.8 kg/m2, and is taking no other medications than thyroid hormone replacement therapy in the course of Hashimoto’s disease. HCVAb/HCV-PCR, HBsAg, anti-HBsAb, and anti HBcAb are negative; IgG is elevated at 1.5 ULN; ANA and ASMA are strongly positive, while AMA are negative. Ultrasound indicates steatosis and there are no bile duct dilatations. Liver biopsy shows a predominantly portal lymphoplasmacytic infiltrate with severe interface hepatitis and lobular hepatitis.
