A rare cause of liver fibrosis in an adult patient

A 41-year-old male, with a BMI of 27.2 kg/m2 and no alcohol consumption for the past 10 years, was referred by the GP to our Liver Unit with the suspicion of non-alcoholic fatty liver disease (NAFLD). The patient underwent a Fibroscan (special ultrasound technology that measures liver stiffness and fatty changes) with a result of 14.7 kPa (normal range: 4-7 kPa). His liver function tests have been persistently normal since presentation with alanine aminotransferase of 41 U/L (N 10-50 U/L), aspartate aminotransferase of 31 U/L (N 10-50 U/L), alkaline phosphatase of 118 U/L (N 0-29 U/L), serum urea of 7.3 mmol/L (N 2.1-7.1) and serum creatinine of 106 μmol/L (N 66-112). An ultrasound scan performed 6 months earlier showed multiple small, simple hepatic cysts, mildly heterogeneous liver echotexture and a multicystic right kidney with bilateral non-obstructive renal stones. The patient underwent a liver biopsy in view of identifying an aetiology for liver fibrosis see above.