Differential Diagnosis

The patient's presentation of elevated liver enzymes, increased alcohol consumption, and abnormal laboratory results suggests a range of potential diagnoses. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Alcoholic Liver Disease (ALD): The patient's increased alcohol consumption and elevated liver enzymes are strongly suggestive of ALD. The ferritin level of 465, while elevated, can be seen in ALD due to inflammation and liver damage.
• Other Likely Diagnoses
  • Non-Alcoholic Fatty Liver Disease (NAFLD): Although the patient consumes alcohol, NAFLD is a common condition that can coexist with ALD, and the elevated ferritin could also be consistent with this diagnosis.
  • Hemochromatosis: The elevated ferritin level could suggest hemochromatosis, a genetic disorder leading to iron overload. However, the Alpha-1-Antitrypsin level is within normal limits, which makes this less likely but still a consideration given the ferritin level.
• Do Not Miss Diagnoses
  • Wilson's Disease: This is a rare genetic disorder that leads to copper accumulation in the liver. Although less likely, missing this diagnosis could be fatal, and it should be considered, especially with elevated liver enzymes and an elevated ferritin level.
  • Autoimmune Hepatitis: Despite the normal autoimmune antibody screen, autoimmune hepatitis can sometimes present with atypical serologies. Given the potential for severe outcomes if untreated, it's crucial not to miss this diagnosis.
• Rare Diagnoses
  • Alpha-1-Antitrypsin Deficiency: Although the Alpha-1-Antitrypsin level is provided as 62, which is within a normal range, and the patient does not have a low level indicative of deficiency, this condition can lead to liver disease. The normal level in this context makes it less likely, but it's a rare condition that could be considered if other factors were present.
  • Other Genetic Liver Diseases: There are several rare genetic liver diseases that could present with elevated liver enzymes and abnormal iron studies. These would be considered if more common diagnoses are ruled out and if there are suggestive clinical or family history features.