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A 50 year old woman presented with progressive jaundice and shortness of breath. She had no history of blood transfusions or recent travel. She had been taking more than 120 g of alcohol per day for 20 years. Her family history was unremarkable. On examination, jaundice, oedema, splenomegaly, and flapping tremor were notable. Laboratory values were as follows: leucocytes 3.8×109/l; haemoglobin 5.6 g/dl; platelet count 33×109/l; alanine aminotransferase 49 IU/l; aspartate aminotransferase 16 IU/l; lactate dehydrogenase 439 IU/l; total bilirubin 15.7 mg/dl; indirect bilirubin 11.4 mg/dl; albumin 2.9 g/dl; cholesterol 205 mg/dl; ferritin 968 μg/l; and prothrombin activity 28%. Tests for hepatitis B surface antigen, anti-hepatitis C virus antibody, antinuclear antibody, and antimitochondrial antibody were negative.
A peripheral blood smear (fig 1) and an abdominal T2 weighed magnetic resonance image (fig 2) are depicted. What is the diagnosis?
See page 1308 for answer
This case is submitted by:
Robin Spiller, Editor