Differential Diagnosis for Elevated Liver Enzymes and Bilirubin in a Young Male

Single Most Likely Diagnosis

• Viral Hepatitis: This is a common cause of elevated liver enzymes (ALP, AST, ALT) and bilirubin in a young male, especially in the absence of fever. Viral hepatitis can cause inflammation of the liver, leading to these laboratory abnormalities.

Other Likely Diagnoses

• Alcoholic Liver Disease: Although the patient is described as young, alcohol use can start early, and alcoholic liver disease can present with elevated liver enzymes and bilirubin.
• Non-Alcoholic Fatty Liver Disease (NAFLD): This condition is increasingly recognized in younger populations and can lead to elevated liver enzymes. However, significant bilirubin elevation is less common in NAFLD without advanced fibrosis or cirrhosis.
• Drug-Induced Liver Injury (DILI): Various medications and supplements can cause liver injury, leading to elevated liver enzymes and bilirubin. The absence of fever does not rule out DILI.

Do Not Miss Diagnoses

• Wilson's Disease: An inherited disorder that leads to copper accumulation in the liver, causing liver damage. It is crucial to consider this diagnosis in young patients with liver enzyme elevations, as early treatment can prevent long-term damage.
• Autoimmune Hepatitis: Although less common, autoimmune hepatitis can present with elevated liver enzymes and bilirubin. It is essential to diagnose and treat this condition to prevent liver failure.
• Budd-Chiari Syndrome: A rare condition caused by thrombosis of the hepatic veins, leading to liver dysfunction. It is critical to consider this diagnosis due to its potential for severe outcomes if not promptly treated.

Rare Diagnoses

• Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver disease and presents with elevated liver enzymes. It is less common but should be considered in the differential diagnosis of liver disease in young individuals.
• Primary Biliary Cholangitis (PBC): An autoimmune disease of the bile ducts that can lead to liver damage. While more common in middle-aged women, it can occur in younger males and should be considered in the differential diagnosis.
• Primary Sclerosing Cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts, which can lead to elevated liver enzymes and bilirubin. It is associated with inflammatory bowel disease and can occur in young males.