Differential Diagnosis for 50-year-old Male with Elevated Ferritin, Normal Blood Counts, Elevated Liver Enzymes, and Low Alkaline Phosphatase

• Single Most Likely Diagnosis
  • Hemochromatosis: This condition is characterized by excessive iron accumulation in the body, leading to elevated ferritin levels. It can cause liver enzyme elevation due to iron overload in the liver. The low alkaline phosphatase level can sometimes be seen in hemochromatosis, especially in the early stages.
• Other Likely Diagnoses
  • Non-Alcoholic Fatty Liver Disease (NAFLD): Elevated liver enzymes and ferritin can be seen in NAFLD, especially if there's an associated iron overload. The low alkaline phosphatase might not be directly related but can be seen in various liver conditions.
  • Chronic Hepatitis: Chronic hepatitis C, in particular, can lead to elevated ferritin levels and liver enzymes. The low alkaline phosphatase could be a nonspecific finding in chronic liver disease.
• Do Not Miss Diagnoses
  • Hepatocellular Carcinoma: Although less likely, hepatocellular carcinoma can present with elevated ferritin and liver enzymes. It's crucial to rule out this diagnosis, especially in the context of chronic liver disease or risk factors for liver cancer.
  • Wilson's Disease: This rare genetic disorder leads to copper accumulation in the liver and can present with elevated liver enzymes and low alkaline phosphatase. Although ferritin might not be directly elevated due to the disease, it's a critical diagnosis not to miss due to its potential for severe liver damage and neurological symptoms.
• Rare Diagnoses
  • African Iron Overload: Similar to hemochromatosis but related to dietary iron intake, this condition can lead to elevated ferritin and liver enzyme elevation.
  • Porphyria Cutanea Tarda: A disorder of porphyrin metabolism that can lead to elevated ferritin and liver enzymes, though it's less common and typically presents with skin manifestations.