Differential Diagnosis for Macrovesicular Steatosis on Liver Biopsy
Single Most Likely Diagnosis
- Non-Alcoholic Fatty Liver Disease (NAFLD): This is the most common cause of macrovesicular steatosis, often associated with obesity, diabetes, and metabolic syndrome. The presence of macrovesicular steatosis on liver biopsy is a hallmark of NAFLD.
Other Likely Diagnoses
- Alcoholic Liver Disease: Chronic alcohol consumption can lead to macrovesicular steatosis, and the history of alcohol use is crucial for differentiating it from NAFLD.
- Hepatic Steatosis due to Medications: Certain medications, such as corticosteroids, tamoxifen, and certain antipsychotics, can cause macrovesicular steatosis.
- Wilson's Disease: Although more commonly associated with microvesicular steatosis, Wilson's disease can occasionally present with macrovesicular steatosis, especially in the early stages.
Do Not Miss Diagnoses
- Acute Fatty Liver of Pregnancy: This rare but life-threatening condition occurs in pregnant women and can present with macrovesicular steatosis. Early recognition is critical for maternal and fetal survival.
- Reye's Syndrome: A rare condition that affects children and teenagers, often following a viral infection, and can cause macrovesicular steatosis. It is associated with high mortality if not promptly recognized and treated.
Rare Diagnoses
- Abetalipoproteinemia: A rare genetic disorder characterized by the inability to absorb dietary fats, leading to macrovesicular steatosis.
- Lipodystrophy: A group of rare disorders characterized by the abnormal distribution of body fat, which can lead to macrovesicular steatosis in the liver.
- Weber-Christian Disease: A rare inflammatory disease of the fatty tissues under the skin and in other organs, including the liver, which can cause macrovesicular steatosis.