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A 59-year-old Japanese man presented to our hospital with loss of appetite and 7 kg decrease in weight over 6 months. His medical history was unremarkable, except for hearing difficulty. He took medication for hypertension. His vital signs and physical examination were normal. Laboratory data at presentation were as follows: total bilirubin 0.4 mg/dl (reference 0.2–1.0); alanine aminotransferase 58 IU/l (reference 10–40); aspartate aminotransferase 68 IU/l (reference 5–40); alkaline phosphatase 697 IU/l (reference 104–338); gamma-glutamyl transpeptidase 178 IU/l (reference 0–79); white blood cells 4300/microlitre (reference 3700–9300); haemoglobin 12.1 g/dl (reference 13.0–16.5); blood urea nitrogen 38 mg/dl (reference 8–20); and creatinine 3.50 mg/dl (reference 0.50–1.20). Tests for hepatitis B and C were negative.
Abdominal ultrasonography demonstrated slightly increased echogenicity of the liver …