Differential Diagnosis for Elevated LFT in a Diabetic Patient

Single Most Likely Diagnosis

• Non-alcoholic fatty liver disease (NAFLD): This is the most likely cause given the patient's history of diabetes, which is a risk factor for NAFLD, and the absence of other liver disease risk factors such as alcohol or drug use. The patient's weight of 90 kg also suggests obesity, another key risk factor for NAFLD.

Other Likely Diagnoses

• Viral hepatitis: Although less likely without specific risk factors mentioned, viral hepatitis (such as hepatitis B or C) can cause chronic liver disease and elevated liver enzymes. It's a common cause of liver enzyme elevation and should be considered, especially if the patient has not been previously screened.
• Autoimmune liver disease: Conditions like autoimmune hepatitis can present with elevated liver enzymes, although they are less common and might be expected to have other symptoms or findings such as elevated autoimmune antibodies.

Do Not Miss Diagnoses

• Hemochromatosis: This genetic disorder leads to iron overload and can cause liver damage. Although less common, missing this diagnosis could lead to significant morbidity and mortality due to the potential for cirrhosis, heart disease, and other complications. It's crucial to consider in any differential for liver disease, especially in a patient without obvious risk factors for other liver conditions.

Rare Diagnoses

• Alpha-1 antitrypsin deficiency: A genetic disorder that can lead to liver disease and might present with elevated liver enzymes. It's rare and less likely but should be considered if common causes are ruled out.
• Wilson's disease: Another genetic disorder that affects copper metabolism and can cause liver disease. It's rare and typically presents at a younger age, but it's a diagnosis that should not be missed due to its potential for severe liver damage and neurological symptoms.